Routine Esophagram After POEM: Clinical Insight | Inspired by Expert Commentary

Introduction

Routine esophagram after POEM has long been considered a safety checkpoint to rule out leaks before resuming oral intake. However, with improved procedural techniques and safety, its real-world value is increasingly being questioned.

Clinical Insight

Recent evidence suggests that clinically significant leaks after POEM are rare and almost always symptomatic. This raises an important question:

👉 Are we performing routine imaging out of habit rather than necessity?

Routine esophagram:

Adds radiation exposure

Increases cost

May delay diet advancement and discharge

Often detects findings that are clinically insignificant

Importantly, most actionable complications would be identified clinically, not radiologically.

Key Message

Routine esophagram has a low diagnostic yield in asymptomatic patients

Clinical symptoms remain the most reliable trigger for intervention

A selective, symptom-driven approach is likely more rational

Conclusion

In the modern POEM era, postoperative care should evolve from protocol-driven to patient-driven decision-making. Routine esophagram may no longer be necessary in all patients, and selective use could improve efficiency without compromising safety.