title: Thoracic CT after peroral endoscopic myotomy for the treatment of achalasia.
abstract: BACKGROUND
  Peroral endoscopic myotomy (POEM) is a promising new endoscopic method for the treatment of achalasia.
  
  
  OBJECTIVE
  The aim of this study was to analyze the value of routine postoperative CT of the chest to detect POEM-associated adverse events.
  
  
  METHODS
  Single-center, retrospective study.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  Between August 2010 and July 2012, 428 patients underwent POEM. Three hundred postprocedure CT POEM patients were retrospectively analyzed and findings correlated with clinical outcome and management.
  
  
  METHODS
  The frequency of postoperative pathological CT scan findings after POEM and the rate of interventions required for adverse event management.
  
  
  RESULTS
  The main CT findings could be divided into frequent and reversible sequelae of POEM, pneumomediastinum (48%), pneumoperitoneum (37%), and subcutaneous emphysema (28%), and into potential adverse events such as pneumothorax (17%), pleural effusion (66%), pneumonitis (52%), and focal atelectasis (21%). Only 17 of 50 patients with pneumothorax (5.6% of all patients) and 2 of 200 patients with pleural effusion (0.7% of all patients) required interventional treatment based on clinical symptoms. In 1 patient, a hematoma was observed on a CT scan before any clinical manifestation occurred. Increasing age and the use of air instead of CO2 were associated with an increased rate of pneumothorax (P = .031; 95% confidence interval, 1.002-1.049 and P < .001; 95% confidence interval, 0.012-0.157, respectively).
  
  
  CONCLUSIONS
  Single-center, retrospective study.
  
  
  CONCLUSIONS
  Routine chest CT scan for achalasia patients undergoing POEM is probably not warranted because of the high rate of minor and clinically irrelevant findings. The use of CO2 is obligatory to reduce related adverse events.
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Ming-Yan
authors.initials: MY
authors.lastname: Cai
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Ping-Hong
authors.initials: PH
authors.lastname: Zhou
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Li-Qing
authors.initials: LQ
authors.lastname: Yao
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Bo-Qun
authors.initials: BQ
authors.lastname: Zhu
authors.affiliation: Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Liang
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Quan-Lin
authors.initials: QL
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002985:Clinical Protocols; D015331:Cohort Studies; D016145:Endoscopy, Digestive System; D004931:Esophageal Achalasia / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008478:Mediastinal Emphysema / Q000000981:diagnostic imaging; D008875:Middle Aged; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000628:therapy; D011014:Pneumonia / Q000000981:diagnostic imaging; D011027:Pneumoperitoneum / Q000000981:diagnostic imaging; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000628:therapy; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D001261:Pulmonary Atelectasis / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D013352:Subcutaneous Emphysema / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult