title: Prospective evaluation of CT esophagram findings after peroral endoscopic myotomy.
abstract: OBJECTIVE
  Peroral endoscopic myotomy (POEM) is a procedure with potential for serious adverse events. Postprocedure imaging is routinely done, yet there is no consensus on the optimal imaging protocol. We describe a novel and simple CT esophagram protocol for evaluation after POEM and for reporting the full spectrum of radiographic findings and subsequent interventions.
  
  
  METHODS
  This was a single-center prospective study of consecutive patients treated with POEM evaluated with CT esophagram.
  
  
  RESULTS
  Eighty-four consecutive patients who had POEM performed underwent CT esophagrams. The most common findings were pneumomediastinum (85.7%), pneumoperitoneum (66.7%), subcutaneous emphysema (52.4%), and pleural effusion (46.4%). Other findings included retroperitoneal air (38.1%), pneumothorax (19%), atelectasis (14.3%), intramural air in the esophagus and/or stomach (13.1%), pericardial effusion (2.4%), and pneumopericardium (2.4%). Five patients required intervention based on CT findings. In 1 patient, a leak was detected on CT esophagram before any clinical manifestation, facilitating prompt intervention and avoiding potential serious outcomes. Four patients were diagnosed with pneumonia and were treated with antibiotics. There was frequent postprocedural atelectasis, which prompted the introduction of routine incentive spirometry in all postoperative POEM cases.
  
  
  CONCLUSIONS
  CT esophagram is a simple and accessible imaging test for routine postoperative POEM evaluation. Numerous and dramatic postprocedure radiographic findings may be expected and demonstrated with this imaging modality. Although most of these findings may not require intervention, some are of potential significance, and early identification may help modify postprocedure management. (
  
  
  BACKGROUND
  NCT01832779.).
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA.
authors.forename: Davinderbir
authors.initials: D
authors.lastname: Pannu
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA.
authors.forename: Dennis
authors.initials: D
authors.lastname: Yang
authors.affiliation: Department of Radiology, University of Florida, Gainesville, Florida, USA.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Abbitt
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA.
authors.forename: Peter V
authors.initials: PV
authors.lastname: Draganov
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016145:Endoscopy, Digestive System; D004931:Esophageal Achalasia / Q000000981:diagnostic imaging / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000000981:diagnostic imaging / Q000601:surgery*; D004947:Esophagus / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008478:Mediastinal Emphysema / Q000000981:diagnostic imaging; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery; D061646:Operative Time; D010996:Pleural Effusion / Q000000981:diagnostic imaging; D011027:Pneumoperitoneum / Q000000981:diagnostic imaging; D011030:Pneumothorax / Q000000981:diagnostic imaging; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011184:Postoperative Period; D011446:Prospective Studies; D013270:Stomach / Q000000981:diagnostic imaging / Q000601:surgery; D013352:Subcutaneous Emphysema / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult