E2496. Do You Really Know How to Read a POEM? Common Upper Gastrointestinal Interventions Evaluated With Postoperative Fluoroscopy
  1. Peter Wang; University of California Irvine
  2. Riya Bansal; University of California Irvine
  3. David Kakish; University of California Irvine
  4. Thomas Duong; University of California Irvine
  5. Sung Park; University of California Irvine
  6. Roozbeh Houshyar; University of California Irvine
  7. Karen Tran-Harding; University of California Irvine
Between recent advancements in gastroenterology and the development of novel surgical and minimally invasive endoscopic techniques, there is now wide variability in the appearance of upper gastrointestinal (UGI) procedures. These include different types of esophageal myotomies, esophagectomies, fundoplications, and bariatric procedures, all of which are routinely evaluated postoperatively using fluoroscopy for the detection of leaks as well as other complications. Therefore, it is important for the radiologist to have an intimate understanding of the procedure that was performed and underlying anatomy to have the optimal approach and examination technique of the target areas. Knowledge of the expected postprocedural imaging findings is crucial for distinguishing normal from potential complications. Radiologists should further discern how to interpret these findings in a meaningful way to the primary clinicians to provide guidelines for the next steps of patient care.

Educational Goals / Teaching Points
We will review cases of postoperative fluoroscopic examinations of select UGI procedures including esophageal myotomy (e.g., Heller’s and peroral endoscopic myotomy [POEM]), esophagectomy (e.g., Ivor Lewis and transhiatal), fundoplication, Whipple procedure, as well as bariatric procedures (e.g., Roux-en-Y gastric bypass, sleeve gastrectomy, and gastric banding). These cases will highlight the indications for the UGI procedures, expected postprocedural imaging appearances, variable complications, and common diagnostic pitfalls.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
UGI fluoroscopy is an invaluable tool for postoperative evaluation due to its ability to detect complications while also allowing for real-time visualization of dynamic processes and the ability to maneuver patients in multiple positions to obtain the most optimal views. It is crucial to understand the optimal fluoroscopic protocol, which depends on each UGI procedure performed and includes timing, type of contrast, areas to target, and positioning of the patients to obtain the best diagnostic images.

Radiologists need to be familiar with many surgical and minimally invasive UGI interventions to be able to appropriately perform postoperative fluoroscopic examinations as well as interpret the subsequent images to provide accurate diagnoses for the ordering providers.