title: Early diagnosis and management of esophageal leakage after peroral endoscopic myotomy for achalasia.
abstract: OBJECTIVE
  To improve the understanding of esophageal leakage after peroral endoscopic myotomy (POEM).
  
  
  METHODS
  From August 2010 to April 2013, patients with postoperative esophageal leakage were identified from the database of cases with achalasia who had undergone POEM and their medical records were reviewed.
  
  
  RESULTS
  Three patients (0.4%, 3/679) developed esophageal leakage after POEM. All three patients had non-severe chest or upper abdominal pain within 3 days after the procedure. Infections were observed, and computed tomography scans showed pleural effusion in all three patients. Pneumonia occurred in two of the three patients. Esophageal leakage was confirmed by gastroscopy. Incision rupture due to an early breaking-off of the clips at the tunnel entry was revealed in two cases. When detected, the entry was immediately closed using metal clips. A thoracic drain was placed in all cases. An enteric feeding tube was also placed to help correct nutrition deficiencies. Successful leakage closure was achieved in all three cases and no surgical intervention was needed.
  
  
  CONCLUSIONS
  Early diagnosis and treatment can improve the status of patients with esophageal leakage after POEM and can shorten the recovery time.
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China. zhou.pinghong@zs-hospital.sh.cn.
authors.forename: Yi Qun
authors.initials: YQ
authors.lastname: Zhang
authors.forename: Li Qing
authors.initials: LQ
authors.lastname: Yao
authors.forename: Mei Dong
authors.initials: MD
authors.lastname: Xu
authors.forename: Quan Lin
authors.initials: QL
authors.lastname: Li
authors.forename: Wei Feng
authors.initials: WF
authors.lastname: Chen
authors.forename: Jian Wei
authors.initials: JW
authors.lastname: Hu
authors.forename: Ming Yan
authors.initials: MY
authors.lastname: Cai
authors.forename: Wen Zheng
authors.initials: WZ
authors.lastname: Qin
authors.forename: Ping Hong
authors.initials: PH
authors.lastname: Zhou
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D004322:Drainage / Q000379:methods; D042241:Early Diagnosis; D004931:Esophageal Achalasia / Q000601:surgery*; D015154:Esophageal Motility Disorders / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D004945:Esophagoscopy / Q000009:adverse effects* / Q000379:methods; D004947:Esophagus / Q000601:surgery; D005260:Female; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000601:surgery; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects*; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000209:etiology; D011014:Pneumonia / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult