Meglumine diatrizoate esophagogram after peroral endoscopic myotomy (POEM): identification of imaging findings associated with clinical complications and longer hospital stay.
Eur Radiol
; 30(8): 4175-4181, 2020 Aug.
Article
em En
| MEDLINE
| ID: mdl-32170414
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.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
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Diatrizoato de Meglumina
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Transtornos da Motilidade Esofágica
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Meios de Contraste
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Esôfago
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Cirurgia Endoscópica por Orifício Natural
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Miotomia
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Tempo de Internação
Tipo de estudo:
Diagnostic_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article