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Meglumine diatrizoate esophagogram after peroral endoscopic myotomy (POEM): identification of imaging findings associated with clinical complications and longer hospital stay

  • Gastrointestinal
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Abstract

Objectives

Esophageal peroral endoscopic myotomy (POEM) is the treatment of reference of major obstructive esophageal motility disorders but the detection of early complications remains challenging. Our aim was to report the radiological findings on meglumine diatrizoate esophagograms after esophageal POEM and identify variables associated with patient outcomes.

Methods

The imaging and clinical files of 106 patients who underwent POEM for achalasia or other major obstructive esophageal motility disorders were retrospectively analyzed. Post POEM esophagograms were reviewed for the presence of pneumoperitoneum, pleural effusion, extraesophageal contrast leakage, and dislocated clips. Associations between length of hospital stay and radiological findings were searched for using a Cox multivariate analysis.

Results

A total of 106 patients (M/F = 56/50; mean age = 50 ± 2 [SD] years) underwent 106 POEM procedures with a meglumine diatrizoate esophagogram on postoperative day 1. Overall median hospital stay was 3 days (range 1–20 days). Pneumoperitoneum, pleural effusion, extraesophageal contrast leakage, and dislocated clips were observed in 90/106 (84.9%), 12/106 (11.3%), 4/106 (3.8%), and 0/106 (0%) patients, respectively. At multivariate analysis, pleural effusion (p = 0.005; adjusted hazard ratio [aHR] = 0.35 [95% CI 0.17–0.73]) and extraesophageal contrast leakage (p = 0.039; aHR = 0.27 [95% CI 0.08–0.94]) were associated with a prolonged hospital stay. Pneumoperitoneum was not associated with unfavorable outcome (p = 0.99).

Conclusions

Pneumoperitoneum is a common finding after POEM and is not indicative of unfavorable patient outcome. Conversely, post POEM pleural effusion and extraesophageal contrast leakage are associated with a longer hospital stay.

Key Points

• Water-soluble esophagogram is a valid diagnostic modality to diagnose early complications after esophageal endoscopic myotomy for esophageal motility disorders.

• At multivariate analysis, pleural effusion and extraesophageal contrast leakage are associated with a prolonged hospital stay after peroral endoscopic myotomy.

• Pneumoperitoneum is not associated with unfavorable outcome after peroral endoscopic myotomy.

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Abbreviations

aHR:

Adjusted hazard ratio

CI:

Confidence interval

CT:

Computed tomography

F:

Female

IQR:

Interquartile range

M:

Male

POEM:

Peroral endoscopic myotomy

SD:

Standard deviation

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The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014, Paris, France

    Maximilien Barret, Sarah Leblanc, Arthur Belle, Einas Abouali, Romain Coriat & Stanislas Chaussade

  2. University of Paris, Descartes Paris 5, 75006, Paris, France

    Maximilien Barret, Anthony Dohan, Einas Abouali, Romain Coriat, Stanislas Chaussade & Philippe Soyer

  3. Department of Abdominal and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014, Paris, France

    Anthony Dohan, Ammar Oudjit & Philippe Soyer

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  1. Maximilien Barret
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  2. Anthony Dohan
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Correspondence to Maximilien Barret.

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The scientific guarantor of this publication is Maximilien Barret.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

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Written informed consent was obtained from all subjects (patients) in this study.

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• Retrospective

• Observational

• Performed at one institution

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Barret, M., Dohan, A., Oudjit, A. et al. Meglumine diatrizoate esophagogram after peroral endoscopic myotomy (POEM): identification of imaging findings associated with clinical complications and longer hospital stay. Eur Radiol 30, 4175–4181 (2020). https://doi.org/10.1007/s00330-020-06758-0

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  • DOI: https://doi.org/10.1007/s00330-020-06758-0

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