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.
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.
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