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DOI: 10.1055/a-1546-8415
Evaluation of timed barium esophagram after per-oral endoscopic myotomy to predict clinical response
TRIAL REGISTRATION: Single-Center, Retrospective Trial NCT02770859 at clinicaltrials.gov![](https://www.thieme-connect.de/media/10.1055-s-00025476/202111/lookinside/thumbnails/2346_10-1055-a-1546-8415-1.jpg)
Abstract
Background and study aims The aim of this study was to evaluate whether timed barium esophagram within 24 hours post-per-oral endoscopic myotomy (POEM) (TBE-PP) could predict clinical outcomes.
Patients and methods This was a single-center retrospective study of prospectively collected data on consecutive patients with ≥ 6-month follow-up who underwent POEM followed by TBE-PP. Esophageal contrast retention 2 minutes after TBE-PP was assessed as Grade 1 (< 10 %), 2 (10 %–49 %), 3 (50 %–89 %) or 4 (> 90 %). Eckardt score, esophagogastroduodenoscopy (EGD), high-resolution manometry (HRM) and function lumen imaging probe (FLIP) of the esophagogastric junction (EGJ) were obtained at baseline. These tests along with pH testing of antisecretory therapy were repeated 6 and 24 months after POEM. Clinical response by Eckardt score ≤ 3, EGJ-distensibility index (EGJ-DI) > 2.8 mm2/mm Hg, and integrated relaxation pressure (IRP) < 15 mm Hg and incidence of gastroesophageal reflux disease (GERD) were compared by transit time.
Results Of 181 patients (58 % male, mean 53 ± 17 yr), TBE-PP was classified as Grade 1 in 122 (67.4 %), Grade 2 in 41 (22.7 %), Grade 3 in 14 (7.7 %) and Grade 4 in 4 (2.2 %). At 6 months, overall clinical response by ES (91.7 %), IRP (86.6 %), EGJ-DI (95.7 %) and the diagnosis of GERD (68.6 %) was similar between Grade 1 and Grade 2–4 TBE-PP. At 24 months, Grade 1 had a higher frequency of a normal IRP compared to Grades 2–4 (95.7 % vs. 60 %, P = 0.021) but overall response by ES (91.2 %), EGJ-DI (92.3 %) and the diagnosis of GERD (74.3 %) were similar.
Conclusions Contrast emptying rate by esophagram after POEM has limited utility to predict clinical response or risk of post-procedure GERD.
Publikationsverlauf
Eingereicht: 17. März 2021
Angenommen: 22. Juni 2021
Artikel online veröffentlicht:
12. November 2021
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Vaezi MF, Pandolfino JE, Yadlapati RH. et al. ACG Clinical Guidelines: Diagnosis and Management of Achalasia. Am J Gastroenterol 2020; 115: 1393-1411
- 2 Werner YB, Hakanson B, Martinek J. et al. Endoscopic or surgical myotomy in patients with idiopathic achalasia. N Engl J Med 2019; 381: 2219-2229
- 3 Ponds FA, Fockens P, Lei A. et al. Effect of peroral endoscopic myotomy vs pneumatic dilation on symptom severity and treatment outcomes among treatment-naive patients with achalasia: a randomized clinical trial. JAMA 2019; 322: 134-144
- 4 Levy JL, Levine MS, Rubesin SE. et al. Findings of esophagography for 25 patients after peroral endoscopic myotomy for achalasia. AJR Am J Roentgenol 2016; 207: 1185-1193
- 5 El Khoury R, Teitelbaum EN, Sternbach JM. et al. Evaluation of the need for routine esophagram after peroral endoscopic myotomy (POEM). Surg Endosc 2016; 30: 2969-2974
- 6 Nast JF, Berliner C, Rösch T. et al. Endoscopy versus radiology in post-procedural monitoring after peroral endoscopic myotomy (POEM). Surg Endosc 2018; 32: 3956-3963
- 7 Reddy CA, Tavakkoli A, Abdul-Hussein M. et al. Clinical impact of routine esophagram after peroral endoscopic myotomy. Gastrointest Endosc 2021; 93: 102-106
- 8 Pannu D, Yang D, Abbitt PL. et al. Prospective evaluation of CT esophagram findings after peroral endoscopic myotomy. Gastrointest Endosc 2016; 84: 408-415
- 9 Cai MY, Zhou PH, Yao LQ. et al. Thoracic CT after peroral endoscopic myotomy for the treatment of achalasia. Gastrointest Endosc 2014; 80: 1046-1055
- 10 de Oliveira JM, Birgisson S, Doinoff C. et al. Timed barium swallow: a simple technique for evaluating esophageal emptying in patients with achalasia. AJR Am J Roentgenol 1997; 169: 473-479
- 11 Vaezi MF, Baker ME, Richter JE. Assessment of esophageal emptying post-pneumatic dilation: use of the timed barium esophagram. Am J Gastroenterol 1999; 94: 1802-1807
- 12 Vaezi MF, Baker ME, Achkar E. et al. Timed barium oesophagram: better predictor of long-term success after pneumatic dilation in achalasia than symptom assessment. Gut 2002; 50: 765-770
- 13 Sternbach JM, El Khoury R, Teitelbaum EN. et al. Early esophagram in per-oral endoscopic myotomy (POEM) for achalasia does not predict long-term outcomes. Surgery 2015; 158: 1128-1135 ; discussion 1135-1136
- 14 Sanaka MR, Chadalavada P, Covut F. et al. Clinical success and correlation of eckardt scores with barium esophagram after peroral endoscopic myotomy in achalasia. J Gastrointest Surg 2021; 25: 278-281
- 15 Eckardt VF, Aignherr C, Bernhard G. Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology 1992; 103: 1732-1738
- 16 Kahrilas PJ, Bredenoord AJ, Fox M. et al. International High Resolution Manometry Working Group. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil 2015; 27: 160-174
- 17 Pandolfino JE, de Ruigh A, Nicodème F. et al. Distensibility of the esophagogastric junction assessed with the functional lumen imaging probe (FLIP™) in achalasia patients. Neurogastroenterol Motil 2013; 25: 496-501
- 18 Roll GR, Rabl C, Ciovica R. et al. A controversy that has been tough to swallow: is the treatment of achalasia now digested?. J Gastrointest Surg 2010; 14: S33-S45
- 19 Lundell LR, Dent J, Bennett JR. et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut 1999; 45: 172-180
- 20 Lawenko RM, Lee YY. Evaluation of gastroesophageal reflux disease using the bravo capsule pH system. J Neurogastroenterol Motil 2016; 22: 25-30
- 21 Gyawali CP, Kahrilas PJ, Savarino E. et al. Modern diagnosis of GERD: the Lyon Consensus. Gut 2018; 67: 1351-1362
- 22 Eckardt VF, Aignherr C, Bernhard G. Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology 1992; 103: 1732-1738
- 23 Carlson DA, Kou W, Lin Z. et al. Normal values of esophageal distensibility and distension-induced contractility measured by functional luminal imaging probe panometry. Clin Gastroenterol Hepatol 2019; 17: 674-681
- 24 Kostic SV, Rice TW, Baker ME. et al. Timed barium esophagogram: A simple physiologic assessment for achalasia. J Thorac Cardiovasc Surg 2000; 120: 935-943
- 25 Tsoukali E, Gouvas N, Tsiaoussis J. et al. Specific esophagogram to assess functional outcomes after Hellerʼs myotomy and Dorʼs fundoplication for esophageal achalasia. Dis Esophagus 2011; 24: 451-457
- 26 Andersson M, Lundell L, Kostic S. et al. Evaluation of the response to treatment in patients with idiopathic achalasia by the timed barium esophagogram: results from a randomized clinical trial. Dis Esophagus 2009; 22: 264-273
- 27 Kachala SS, Rice TW, Baker ME. et al. Value of routine timed barium esophagram follow-up in achalasia after myotomy. J Thorac Cardiovasc Surg 2018; 156: 871-877
- 28 Oezcelik A, Hagen JA, Halls JM. et al. An improved method of assessing esophageal emptying using the timed barium study following surgical myotomy for achalasia. J Gastrointest Surg 2009; 13: 14-18
- 29 Zanoni A, Rice TW, Lopez R. et al. Timed barium esophagram in achalasia types. Dis Esophagus 2015; 28: 336-344
- 30 Vela MF, Richter JE, Khandwala F. et al. The long-term efficacy of pneumatic dilatation and Heller myotomy for the treatment of achalasia. Clin Gastroenterol Hepatol 2006; 4: 580-587
- 31 Blam ME, Delfyett W, Levine MS. et al. Achalasia: a disease of varied and subtle symptoms that do not correlate with radiographic findings. Am J Gastroenterol 2002; 97: 1916-1923
- 32 Shah R, Cai Q. Clinical utility of routine post-peroral endoscopic myotomy imaging: Does clinical decision making outweigh the protocol. Gastrointest Endosc 2021; 93: 107-109
- 33 Foisy H, Pioche M, Chabrun E. et al. Role of rapid drink challenge during esophageal high-resolution manometry in predicting outcome of peroral endoscopic myotomy in patients with achalasia. J Neurogastroenterol Motil 2020; 26: 204-214