Background: Per Oral Endoscopic Myotomy (POEM) is a promising new endoscopic method for the treatment of achalasia cardia. Available current data from various meta-analyses shows short term success with minimal adverse events. Here we aim to study the post procedural adverse events of POEM procedure using postoperative low dose multi detector CT chest with oral contrast. Methods: A retrospective study involving 43 patients who underwent POEM procedure for achalasia, were evaluated on postoperative day 1 chest CT study with oral contrast. Results: 30 out of the 43 patients (69.8%) had pleural effusion. 29 cases (67.5%) had small pleural effusion and one case (2.3%) had moderate effusion. None had large pleural effusion. Small left pneumothorax was noted in 1 patient (2.3%), which was however not severe enough to produce respiratory complaints or necessitated intercostal drain tube placement. One patient had 2 mucosal defects in the lower oesophagus with submucosal and extra luminal contrast leak, causing mediastinal collection and communication with left pleural cavity resulting in empyema which required intercostal drainage. Minimal intramural contrast leak with no extraluminal leak or mediastinal collection was present in 5 patients (11.6%), and all 5 were managed with second clipping. Bilteral lower lobe consolidation was noted in 1 case (2.3%), suggesting the possibility of aspiration. The patient had an uneventful postoperative course obviating the necessity of any further specific management. Minimal basal atelectasis were seen in 8 patients (18.4%), few linear opacities suggestive of pneumonitis were seen in 2 patients (4.6%), pneumomediastinum was found in 11 patients (25.5%), pneumoperitoneum in 24 patients (60.5%) and subcutaneous emphysema in 12 patients (28%). None of them were severe enough to produce clinical effects and none required any specific intervention. Conclusion: POEM procedure being preferred now in the management of achalasia cardia, it is of pertinent importance for the radiologists to be aware of the adverse events that could occur post procedure, and to differentiate the expected postoperative findings from the more sinister complications like perforation, which causes significant morbidity and mortality.

Background: Sleep MRI is a new emerging non invasive modality in the preoperative evaluation of patients with obstructive sleep apnoea. Rather than subjective, the aim of the study is to evaluate the competency of certain dynamic and static parameters (variables and diemensions), that can be used in day to day reporting. Incorporating such parameters, may prove to be helpful in guiding surgical decision making. Materials and Methods: A retrospective analytical study included 27 subjects with OSA aged between 18 and 70 years using 1.5 T MRI . We measured variables such as the cross-sectional area and diameter of the retropalatal and retroglossal airway during the asleep and awakened states.We also measured comprehensive airway dimensions such as antero-posterior diameter of the tongue, midline saggital diameter of tongue, intermandibular rami distance, mentum spine distance and relative size of the tongue using the spine as the posterior border of the bony confines. Results: 21 patients had significant retropalatal airway compromise, and was evidenced by statistically significant variables in awakened and asleep states. The mean minimum anterior–posterior diameter (mm) of retropalatal airway during respiratory cycle was statistically significant measuring 3.1±1.5 mm in awaken state and 1.1±1.5 mm during asleep state (p- value 0.01). The mean minimum cross sectional area during respiratory cycle was statistically significant measuring 98±11 mm2 in awaken state and 63 ±12 mm2 during asleep state (p- value 0.04). 6 patients had significant retroglossal airway compromise, and was evidenced by statistically significant. The thickness of the soft palate and the relative size of the tongue (0.5± 0.01mm) was statistically significant in these patients (p- value 0.01). Conclusion: Our study shows that retropalatal airway is a significant cause of obstruction in patients with OSA, compared with retroglossal airway. We suggest that, when the compromise of the retroplatine aiway is to be evaluated, variables such as cross sectional area and antero-posterior diameter of the retropalatal airway during the respiratory phase in asleep and awakened states proves valuable and dimensions such as soft palate thickness as tool for objective measurement of OSA. When the compromise of the retroglossal aiway is to be evaluated, the relative size of the tongue , proves offers more advantage than the variables of airway compromise such as area and antero-posterior diameter.To further evaluate if some of our parameters correlate with the outcomes of the surgeries of OSA, a multivariate analysis would have been required.