Routine X-ray contrast study after peroral endoscopic myotomy does not improve patient outcomes.

Area of Science:

• Gastroenterology
• Surgical Innovation
• Patient Care Pathways

Background:

• Peroral endoscopic myotomy (POEM) is a leading treatment for achalasia.
• Traditional protocols involve X-ray contrast studies to rule out leaks before initiating oral feeding.
• The necessity of routine X-ray studies is questioned due to the rarity of major adverse events (AEs) post-POEM.

Purpose of the Study:

• To compare the efficacy and safety of routine post-POEM X-ray contrast studies versus a clinical decision-based approach for initiating oral feeding.
• To evaluate the impact of these strategies on complication rates and hospital stay duration.

Main Methods:

• Retrospective analysis of 271 POEM procedures conducted between 2015 and 2023.
• Patients were categorized into two groups: 'X-ray subgroup' (feeding post-negative X-ray) and 'clinical decision subgroup' (feeding based on clinical judgment).
• Primary outcomes included major/minor AEs and length of hospital stay.

Main Results:

• No significant difference in overall AE rates between the X-ray (15.1%) and clinical decision (15.2%) groups.
• Major AEs were comparable: 3.8% in the X-ray group vs. 1.2% in the clinical decision group (p=NS).
• The clinical decision group experienced a shorter hospital stay (6.6 days vs. 7.2 days, p=0.05).

Conclusions:

• Severe complications following POEM are infrequent.
• Routine post-POEM X-ray contrast studies do not demonstrably reduce the rate of adverse events.
• A clinical decision-based approach for initiating oral intake is safe and associated with shorter hospitalizations.