Routine esophagram to detect early esophageal leakage after peroral endoscopic myotomy

Abstract

Background Peroral endoscopic myotomy (POEM) is highly successful in treating patients with achalasia. The aim of this study was to evaluate the incidence of early adverse events (AEs) following POEM and to assess whether post-procedural imaging by routine esophagram prevents serious AEs due to early detection of esophageal leakage after POEM. Methods Patients who underwent POEM between August 2011 and December 2022 were included in this retrospective cohort study. Post-procedural AEs were graded according to the AGREE classification. Until July 2016 routine esophagram was routinely performed one day after POEM, afterwards this was abandoned. The number and severity of post-procedural AEs were compared between patients with and without routine esophagram after POEM. Results In total, 352 patients were included (mean age 47 years, 48.3% female). Nineteen post-procedural AEs occurred of which ten were grade I (2.8%), three grade II (0.9%), five grade IIIa (1.4%) and one grade IVa (0.3%). No difference was found in the number and severity of post-procedural AEs between patients with and without routine esophagram . In 129 patients routine esophagram was performed one day after POEM. In two patients esophageal leakage was seen after which repeat endoscopy was performed to close the incision with additional clips. After abolishing routine esophagram from the protocol, no AEs led to severe complications related to esophageal leakage. Conclusion POEM is safe with relatively low number of AEs. The benefit of routine esophagram one day after POEM is limited as it does not prevent serious complications resulting from esophageal leakage.