title: Early esophagram in per-oral endoscopic myotomy (POEM) for achalasia does not predict long-term outcomes.
abstract: BACKGROUND
  In the recently reported international survey of centers performing per-oral endoscopic myotomy (POEM), 88% of operators reported obtaining routinely an early postoperative contrast esophagram. To date, there have been no studies to assess the prognostic value of early esophagram in POEM.
  
  
  METHODS
  A retrospective review of a prospectively maintained, single-institution database of patients who underwent POEM for treatment of achalasia was conducted. Patients were evaluated with a routine contrast esophagram on the first postoperative day (POD#1) to assess for perforation. The finding of delayed esophageal emptying, as determined by an attending radiologist, was compared with the patients' symptomatic outcomes and functional parameters at one year follow-up.
  
  
  RESULTS
  Contrast esophagram was obtained on POD#1 for 72 patients undergoing POEM; 26 patients (36%) were observed to have a delay in esophageal emptying. Both groups of patients, those with a delay and those without a delay in esophageal emptying on POD#1, had similar preoperative Eckardt scores (7 ± 2 vs 7 ± 2, P = ns) and column height at 5 minutes on preoperative timed barium esophagram (12.1 ± 8 cm vs 14.1 ± 8 cm, P = ns). At a mean follow-up of 1 year, there was no difference in Eckardt scores between patients with and those without a delay in emptying on POD#1 esophagram (1 ± 2 vs 1 ± 1, P = ns), nor was there a difference between the 2 groups in column height at 5 minutes on TBE (5.5 ± 5 cm for delay vs 4.2 ± 4 cm for no delay; P = ns). Rates of treatment failure, as measured by Eckardt score >3 or need for subsequent treatment, also did not differ between the 2 groups (3 patients with delay vs 4 patients without delay in emptying, P = ns).
  
  
  CONCLUSIONS
  Delay in passage of contrast on POD#1 esophagram did not predict symptomatic or physiologic outcomes at 1-year follow-up in patients undergoing POEM for treatment of achalasia.
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Sternbach
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Rym
authors.initials: R
authors.lastname: El Khoury
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Ezra N
authors.initials: EN
authors.lastname: Teitelbaum
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Nathaniel J
authors.initials: NJ
authors.lastname: Soper
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: John E
authors.initials: JE
authors.lastname: Pandolfino
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, IL. Electronic address: ehungnes@nm.org.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Hungness
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D004931:Esophageal Achalasia / Q000000981:diagnostic imaging* / Q000601:surgery; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery; D011182:Postoperative Care / Q000379:methods*; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome