Evaluation of timed barium esophagram after per-oral endoscopic myotomy to predict clinical response
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 d...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Georg Thieme Verlag KG
2021-11-01
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| Series: | Endoscopy International Open |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/a-1546-8415 |
| _version_ | 1818837060070408192 |
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| author | John M. DeWitt Robert M. Siwiec Anthony Perkins Daniel Baik William R. Kessler Thomas V. Nowak John M. Wo Toyia James-Stevenson Martha Mendez Destenee Dickson Sarah Stainko Fatih Akisik John Lappas Mohammad A. Al-Haddad |
| author_facet | John M. DeWitt Robert M. Siwiec Anthony Perkins Daniel Baik William R. Kessler Thomas V. Nowak John M. Wo Toyia James-Stevenson Martha Mendez Destenee Dickson Sarah Stainko Fatih Akisik John Lappas Mohammad A. Al-Haddad |
| author_sort | John M. DeWitt |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-19T03:16:29Z |
| format | Article |
| id | doaj.art-1da8edc5fc824bb59ae29a359cfb58ed |
| institution | Directory Open Access Journal |
| issn | 2364-3722 2196-9736 |
| language | English |
| last_indexed | 2024-12-19T03:16:29Z |
| publishDate | 2021-11-01 |
| publisher | Georg Thieme Verlag KG |
| record_format | Article |
| series | Endoscopy International Open |
| spelling | doaj.art-1da8edc5fc824bb59ae29a359cfb58ed2022-12-21T20:37:52ZengGeorg Thieme Verlag KGEndoscopy International Open2364-37222196-97362021-11-010911E1692E170110.1055/a-1546-8415Evaluation of timed barium esophagram after per-oral endoscopic myotomy to predict clinical responseJohn M. DeWitt0Robert M. Siwiec1Anthony Perkins2Daniel Baik3William R. Kessler4Thomas V. Nowak5John M. Wo6Toyia James-Stevenson7Martha Mendez8Destenee Dickson9Sarah Stainko10Fatih Akisik11John Lappas12Mohammad A. Al-Haddad13Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United StatesDepartment of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United StatesDepartment of Biostatistics, Indiana University Health Medical Center, Indianapolis, Indiana, United StatesDepartment of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United StatesDepartment of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United StatesDepartment of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United StatesDepartment of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United StatesDepartment of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United StatesDepartment of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United StatesDepartment of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United StatesDepartment of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United StatesDepartment of Radiology, Indiana University Health Medical Center, Indianapolis, Indiana, United StatesDepartment of Radiology, Indiana University Health Medical Center, Indianapolis, Indiana, United StatesDepartment of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United StatesBackground 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.http://www.thieme-connect.de/DOI/DOI?10.1055/a-1546-8415 |
| spellingShingle | John M. DeWitt Robert M. Siwiec Anthony Perkins Daniel Baik William R. Kessler Thomas V. Nowak John M. Wo Toyia James-Stevenson Martha Mendez Destenee Dickson Sarah Stainko Fatih Akisik John Lappas Mohammad A. Al-Haddad Evaluation of timed barium esophagram after per-oral endoscopic myotomy to predict clinical response Endoscopy International Open |
| title | Evaluation of timed barium esophagram after per-oral endoscopic myotomy to predict clinical response |
| title_full | Evaluation of timed barium esophagram after per-oral endoscopic myotomy to predict clinical response |
| title_fullStr | Evaluation of timed barium esophagram after per-oral endoscopic myotomy to predict clinical response |
| title_full_unstemmed | Evaluation of timed barium esophagram after per-oral endoscopic myotomy to predict clinical response |
| title_short | Evaluation of timed barium esophagram after per-oral endoscopic myotomy to predict clinical response |
| title_sort | evaluation of timed barium esophagram after per oral endoscopic myotomy to predict clinical response |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/a-1546-8415 |
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