title: Findings of Esophagography for 25 Patients After Peroral Endoscopic Myotomy for Achalasia.
abstract: OBJECTIVE
  The purpose of this study is to better characterize the findings of esophagography after peroral endoscopic myotomy for achalasia.
  
  
  METHODS
  We evaluated 25 patients who underwent peroral endoscopic myotomy for achalasia. The findings noted on pre- and postprocedural esophagrams were reviewed retrospectively and were correlated with clinical outcomes.
  
  
  RESULTS
  None of the patients had esophageal perforation noted on esophagrams obtained after myotomy, and all but two patients had a hospital stay that lasted 1 day only. Esophagrams obtained on postoperative day 1 revealed endoscopic clips in 25 patients (100%), pneumoperitoneum in 18 (72%), retroperitoneal gas in 10 (40%), gastric pneumatosis in nine (36%), intramural dissections in seven (28%), and pneumomediastinum in four (16%). Repeat esophagrams obtained 3 weeks later for 22 of the patients revealed endoscopic clips in 16 patients (73%) and intramural dissections in five patients (23%), but the remaining findings had resolved. Eighteen patients (72%) had a successful myotomy and seven (28%) had suboptimal results on the basis of clinical outcomes. Observation of a distal esophageal width of 5 mm or less on postprocedural esophagrams was often associated with suboptimal results.
  
  
  CONCLUSIONS
  Peroral endoscopic myotomy is a novel procedure that is less invasive than is laparoscopic Heller myotomy for the treatment of achalasia, with fewer complications and shorter recovery times. Radiologists should be aware of the findings expected on esophagography (including pneumoperitoneum, retroperitoneal gas, gastric pneumatosis, intramural dissections, and pneumomediastinum) and should also know that fluoroscopic studies may be helpful for predicting patient outcomes on the basis of the width of the distal esophagus after myotomy.
authors.affiliation: 1 Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Levy
authors.affiliation: 1 Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104.
authors.forename: Marc S
authors.initials: MS
authors.lastname: Levine
authors.affiliation: 1 Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Rubesin
authors.affiliation: 2 Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Gary W
authors.initials: GW
authors.lastname: Falk
authors.affiliation: 2 Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: David C
authors.initials: DC
authors.lastname: Metz
authors.affiliation: 3 Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Dempsey
authors.affiliation: 2 Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Ginsberg
mesh_terms: D000328:Adult; D000368:Aged; D004931:Esophageal Achalasia / Q000000981:diagnostic imaging* / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
keywords: achalasia; barium esophagography; esophagography; peroral endoscopic myotomy (POEM); radiographic findings