Chest CT in the management of post-POEM achalasia

Dr. Cai and Dr. ZhouMing-Yan Cai, MD and Ping-Hong Zhou, MD, PhD from the Endoscopy Center at Zhongshan Hospital at Fudan University in Shanghai, China discuss their Original Article “Thoracic CT after peroral endoscopic myotomy for the treatment of achalasia.” 

The focus of this study was to analyze the value of routine postoperative computed tomography (CT) of the chest for detection of peroral endoscopic myotomy (POEM)-associated adverse events.

We feel that it is important to correlate the findings on routine chest CT scan with clinically significant adverse events of POEM to guide our daily practice.

Figure 2Figure 2. Positive CT findings of post-peroral endoscopic myotomy patients. A, Pleural effusion (arrow). B, Pneumonitis (arrow). C, Pneumomediastinum (arrow). D, Pneumoperitoneum (arrow). E, Subcutaneous emphysema (arrow). F, Pneumothorax (arrows) with lung compression greater than 30% needed an intervention.

The chest CT findings revealed a high rate of pleural and pulmonal affection: pleural effusion (66.7%), pneumonitis (52.7%), and pneumomediastinum (48.3%) were frequently seen, followed by other adverse events such as pneumoperitoneum (37.7%), subcutaneous emphysema (28.7%), focal atelectasis (21%) and pneumothorax (16.7%). Arguably, they are related to air insufflation before they switched to CO2. Only 17/50 patients with pneumothorax (5.6% of all cases) and 2/200 patients with pleural effusion (0.7% of all cases) required interventional treatment based on clinical symptoms.The clinical value of post-procedure routine CT is very limited. We suggest to selectively use post-POEM CT in symptomatic post-POEM patients.

The value of chest CT scan in symptomatic post-POEM patients needs to be further studied.

Find the abstract for this article here.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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