Early esophagram in per-oral endoscopic myotomy (POEM) for achalasia does not predict long-term outcomes

Background. In the recently reported international survey of centers performing per-oral endoscopic myotomy (POEM), 88% of operators reported obtaining routinely an early postoperative contrast esophagram. To date, there have been no studies to assess the prognostic value of early esophagram in POEM. Methods. A retrospective review of a prospectively maintained, single-institution database of patients who underwent POEM for treatment of achalasia was conducted. Patients were evaluated with a routine contrast esophagram on the first postoperative day (POD#1) to assess for perforation. The finding of delayed esophageal emptying, as determined by an attending radiologist, was compared with the patients' symptomatic outcomes and functional parameters at one year follow-up. Results. Contrast esophagram was obtained on POD#1 for 72 patients undergoing POEM; 26 patients (36%) were observed to have a delay in esophageal emptying. Both groups of patients, those with a delay and those without a delay in esophageal emptying on POD#1, had similar preoperative Eckardt scores (7 +/- 2 vs 7 +/- 2, P = ns) and column height at 5 minutes on preoperative timed barium esophagram (12.1 +/- 8 cm vs 14.1 +/- 8 cm, P = ns). At a mean follow-up of 1 year, there was no difference in Eckardt scores between patients with and those without a delay in emptying on POD#1 esophagram (1 2 vs 1 1, P = ns), nor was there a difference between the 2 groups in column height at 5 minutes on TBE (5.5 +/- 5 cm for delay vs 4.2 +/- 4 cm for no delay; P = ns). Rates of treatment failure, as measured by Eckardt score > 3 or need for subsequent treatment, also did not differ between the 2 groups (3 patients with delay vs 4 patients without delay in emptying, P = ns). Conclusion. Delay in passage of contrast on POD#1 esophagram did not predict symptomatic or physiologic outcomes at 1-year follow-up in patients undergoing POEM for treatment of achalasia.