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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(11): E1692-E1701
DOI: 10.1055/a-1546-8415
Original article

Evaluation of timed barium esophagram after per-oral endoscopic myotomy to predict clinical response

John M. DeWitt
1   Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United States
,
Robert M. Siwiec
1   Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United States
,
Anthony Perkins
2   Department of Biostatistics, Indiana University Health Medical Center, Indianapolis, Indiana, United States
,
Daniel Baik
1   Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United States
,
William R. Kessler
1   Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United States
,
Thomas V. Nowak
1   Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United States
,
John M. Wo
1   Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United States
,
Toyia James-Stevenson
1   Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United States
,
Martha Mendez
1   Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United States
,
Destenee Dickson
1   Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United States
,
Sarah Stainko
1   Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United States
,
Fatih Akisik
3   Department of Radiology, Indiana University Health Medical Center, Indianapolis, Indiana, United States
,
John Lappas
3   Department of Radiology, Indiana University Health Medical Center, Indianapolis, Indiana, United States
,
Mohammad A. Al-Haddad
1   Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United States
› Author AffiliationsTRIAL REGISTRATION: Single-Center, Retrospective Trial NCT02770859 at clinicaltrials.gov
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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.

Supplementary material



Publication History

Received: 17 March 2021

Accepted: 22 June 2021

Article published online:
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/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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