Thoracic CT after peroral endoscopic myotomy for the treatment of achalasia

Background: Peroral endoscopic myotomy (POEM) is a promising new endoscopic method for the treatment of achalasia. Objective: The aim of this study was to analyze the value of routine postoperative CT of the chest to detect POEM-associated adverse events. Design: Single-center, retrospective study. Setting: Tertiary care center. Patients and Interventions: Between August 2010 and July 2012, 428 patients underwent POEM. Three hundred postprocedure CT POEM patients were retrospectively analyzed and findings correlated with clinical outcome and management. Main Outcome Measurements: The frequency of postoperative pathological CT scan findings after POEM and the rate of interventions required for adverse event management. Results: The main CT findings could be divided into frequent and reversible sequelae of POEM, pneumomediastinum (48%), pneumoperitoneum (37%), and subcutaneous emphysema (28%), and into potential adverse events such as pneumothorax (17%), pleural effusion (66%), pneumonitis (52%), and focal atelectasis (21%). Only 17 of 50 patients with pneumothorax (5.6% of all patients) and 2 of 200 patients with pleural effusion (0.7% of all patients) required interventional treatment based on clinical symptoms. In 1 patient, a hematoma was observed on a CT scan before any clinical manifestation occurred. Increasing age and the use of air instead of CO2 were associated with an increased rate of pneumothorax (P = .031; 95% confidence interval, 1.002-1.049 and P < .001; 95% confidence interval, 0.012-0.157, respectively). Limitations: Single-center, retrospective study. Conclusions: Routine chest CT scan for achalasia patients undergoing POEM is probably not warranted because of the high rate of minor and clinically irrelevant findings. The use of CO2 is obligatory to reduce related adverse events.