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Related Experiment Video

Updated: Aug 12, 2025

Adapting Human Videofluoroscopic Swallow Study Methods to Detect and Characterize Dysphagia in Murine Disease Models
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Post-POEM Contrast-Enhanced Swallow Study: Is It Always Necessary?

Gabriel Szydlo Shein1, Ram Elazary1,2, Gad Marom1,2

  • 1Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel.

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
|January 31, 2023
PubMed
Summary
This summary is machine-generated.

Routine contrast-enhanced swallow studies (CESS) after peroral endoscopic myotomy (POEM) for achalasia may not be necessary. Clinical signs like fever or elevated white blood cell counts can effectively screen for complications, potentially reducing the need for CESS.

Keywords:
AchalasiaContrast-enhanced swallow studyNOTESPeroral endoscopic myotomy (POEM)Tunnel leak

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Area of Science:

  • Gastroenterology
  • Endoscopic Surgery
  • Diagnostic Imaging

Background:

  • Peroral endoscopic myotomy (POEM) is a leading treatment for esophageal achalasia.
  • Contrast-enhanced swallow studies (CESS) are commonly used post-POEM to check for mucosal integrity.
  • The necessity of routine CESS after POEM requires evaluation.

Purpose of the Study:

  • To assess the routine necessity of postoperative contrast-enhanced swallow studies (CESS) after peroral endoscopic myotomy (POEM).
  • To determine if clinical and laboratory findings can effectively screen for complications post-POEM, potentially obviating routine CESS.

Main Methods:

  • Retrospective review of a prospectively maintained database of 134 patients who underwent POEM.
  • Analysis of postoperative day 1 (POD-1) CESS results, vital signs, and complete blood counts.
  • Evaluation of the correlation between clinical/laboratory findings and CESS results for detecting complications.

Main Results:

  • 51.49% of CESS showed abnormal findings, but most did not impact the postoperative course.
  • Five patients (7.2%) had tunnel leaks identified by CESS, altering management.
  • POD-1 clinical signs (fever, tachycardia) and leukocytosis demonstrated 100% sensitivity for detecting clinically significant complications.

Conclusions:

  • Routine CESS post-POEM may not be necessary for all patients.
  • Clinical and laboratory abnormalities are sensitive indicators for screening significant complications.
  • An algorithm for selective CESS based on objective findings is proposed to optimize patient care.