STS 2026 Consensus: CT Esophagram Preferred Over Fluoroscopy, Imaging Optional in Spontaneous Pneumomediastinum

STS 2026 consensus: CT esophagram preferred over fluoroscopy for suspected esophageal perforation; imaging can be omitted in spontaneous pneumomediastinum. Endoscopic stenting or vacuum therapy recommended based on individual factors.

• CT esophagram is now preferred over fluoroscopy as the first-line diagnostic imaging modality.
• In cases of spontaneous pneumomediastinum, further imaging may be omitted entirely.
• Endoscopic therapies, including stenting and vacuum therapy, are emphasized over traditional surgical approaches based on individual patient factors.

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