Abstract
Introduction
The timed barium study (TBS) is used to assess esophageal emptying in patients with achalasia. Improvement in emptying correlates with outcome after endoscopic therapy, but the results of the TBS have been variable after myotomy. Our aim was to evaluate a new method for assessing improvement in emptying after myotomy.
Methods
A TBS was performed before and 3–6 months after myotomy in 30 patients. Emptying was assessed by measuring the percent difference in area of the barium column on films obtained 1 and 5 min after ingesting 150 ml of barium. Initial esophageal clearance was also assessed by comparing the area of the barium column on 1-min images obtained before and after therapy. Both measures were compared to clinical outcome.
Results
After myotomy, 21 patients (70%) had no symptoms, four (13%) had mild, and five (17%) had moderate/severe symptoms. Using the standard method, esophageal emptying before and after surgery were not significantly different (25% vs. 37%; p = 0.22) and did not correlate with clinical outcome. In contrast, initial esophageal clearance improved significantly (median 81%) and correlated with clinical outcome.
Conclusion
Esophageal emptying measured by the standard method is not useful to assess outcome after myotomy. However, initial esophageal clearance correlates well with clinical outcome.
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References
Litle VR. Laparoscopic Heller myotomy for achalasia: a review of the controversies. Ann Thorac Surg 2008;85(2):S743–S746. doi:10.1016/j.athoracsur.2007.12.004.
Kostic SV, Rice TW, Baker ME, et al. Timed barium esophagogram: a simple physiologic assessment for achalasia. J Thorac Cardiovasc Surg 2000;120(5):935–943. doi:10.1067/mtc.2000.110463.
Rakita S, Villadolid D, Kalipersad C, et al. Outcomes promote reoperative Heller myotomy for symptoms of achalasia. Surg Endosc 2007;21(10):1709–1714. doi:10.1007/s00464-007-9226-8.
Iqbal A, Tierney B, Haider M, et al. Laparoscopic re-operation for failed Heller myotomy. Dis Esophagus 2006;19(3):193–199. doi:10.1111/j.1442-2050.2006.00564.x.
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(2):473–479.
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(8):1916–1923. doi:10.1111/j.1572-0241.2002.05900.x.
Birgisson S, Richter JE. Achalasia: what’s new in diagnosis and treatment? Dig Dis 1997;15(Suppl 1):1–27.
Vaezi MF, Baker ME, Achkar E, Richter JE. Timed barium oesophagram: better predictor of long term success after pneumatic dilation in achalasia than symptom assessment. Gut 2002;50(6):765–770. doi:10.1136/gut.50.6.765.
Patti MG, Gorodner MV, Galvani C, et al. Spectrum of esophageal motility disorders: implications for diagnosis and treatment. Arch Surg 2005;140(5):442–448. discussion 448–449doi:10.1001/archsurg.140.5.442.
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Previous presentations: 49th SSAT Annual Meeting at Digestive Disease Week, San Diego, 2008 and 23rd Annual SSAT Residents and Fellows Research Conference, San Diego, 2008
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Oezcelik, A., Hagen, J.A., Halls, J.M. et al. An Improved Method of Assessing Esophageal Emptying Using the Timed Barium Study Following Surgical Myotomy for Achalasia. J Gastrointest Surg 13, 14–18 (2009). https://doi.org/10.1007/s11605-008-0730-5
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DOI: https://doi.org/10.1007/s11605-008-0730-5