Clinical Success and Correlation of Eckardt Scores with Barium Esophagram After Peroral Endoscopic Myotomy in Achalasia

Sanaka, Madhusudan; Chadalavada, Pravallika; Covut, Fahrettin; Khoudari, George; Gabbard, Scott; Thota, Prashanthi N.; Raja, Siva

doi:10.1007/s11605-020-04763-8

Cited by 5 publications

(18 citation statements)

References 5 publications

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“…Furthermore, wider esophageal diameter, higher barium column height or poor emptying from TBE following Heller myotomy for achalasia reportedly may predict risk of procedure failure or lack of symptom relief 24 25 26 27 28 . However, previous studies suggest that delay in contrast passage after POEM does not predict clinical outcomes 4 13 14 and often reports findings that are clinically irrelevant in stable patients and may lead to unnecessary post-procedure interventions 6 7 8 9 . We found that 2 years after POEM, after adjusting for baseline IRP and other clinical characteristics, rapid (< 10 % retention) predicted a lower IRP compared to those with mild-severe contrast delay but did not predict a normalized Eckardt score or other variables assessed.…”

Section: Discussionmentioning

confidence: 99%

“…TBE after dilation can identify patients who may require repeat intervention 11 and is more effective than patient reported outcomes to predict treatment response 12 . Despite these findings, delay in esophagram contrast passage after POEM does not appear to predict clinical outcomes 4 13 14 thus raising questions about its utility in this setting.…”

Section: Introductionmentioning

confidence: 99%

“…Given its apparent limited utility in predicting clinically relevant AEs or patient outcomes, some authors have suggested that post-POEM imaging may not be warranted 5 6 9 . However, studies evaluating the role of esophagram after POEM are often retrospective 4 5 6 7 9 13 14 or use non-standardized or unspecified esophagram protocols 5 7 13 to report clinical outcomes. Therefore, precise determination of the utility of imaging after POEM to determine clinical response or need for post-procedure intervention remains inconclusive.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…The long-term clinical success of POEM in recent studies has ranged from 72% to 96% at follow-up durations of 36 to 120 months (Table 1). [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] POEM has also been compared to pneumatic dilatation (PD) and Heller's myotomy (HM) in several retrospective cohort studies, suggesting a similar or even superior efficacy of POEM. 30 More recently, two landmark randomized trials compared POEM to PD and HM.…”

Section: ) Esophageal Motility Disorders (Poem)mentioning

confidence: 99%

Submucosal endoscopy: the present and future

Nabi

Reddy

2023

Clin Endosc

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Submucosal endoscopy or third-space endoscopy utilizes the potential space between the mucosal and muscularis layers of the gastrointestinal tract to execute therapeutic interventions for various diseases. Over the last decade, endoscopic access to the submucosal space has revolutionized the field of therapeutic endoscopy. Submucosal endoscopy was originally used to perform endoscopic myotomy in patients with achalasia cardia, and its use has grown exponentially since. Currently, submucosal endoscopy is widely used to resect subepithelial tumors and to manage refractory gastroparesis and Zenker's diverticulum. While the utility of submucosal endoscopy has stood the test of time in esophageal motility disorders and subepithelial tumors, its durability remains to be established in conditions such as Zenker's diverticulum and refractory gastroparesis. Other emerging indications for submucosal endoscopy include esophageal epiphrenic diverticulum, Hirschsprung's disease, and esophageal strictures not amenable to conventional endoscopic treatment. The potential of submucosal endoscopy to provide easy and safe access to the mediastinum and peritoneal spaces may open doors to novel indications and rejuvenate the interest of endoscopists in natural orifice transluminal endoscopic surgery in the future. This review focuses on the current spectrum, recent updates, and future direction of submucosal endoscopy in the gastrointestinal tract.

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“…Esophagoscopy is the gold standard for esophageal cancer diagnosis, but it is both invasive and expensive (3). Barium esophagram can simultaneously detect morphologic and functional abnormalities in the esophagus and is thus a valuable technique for the assessment of esophageal cancer (4)(5)(6)(7). In addition, due to its inexpensive and noninvasive features, as well as its widespread availability, the barium esophagram is usually prioritized over other techniques, such as endoscopy, for clinical diagnostic selection (4).…”

Section: Introductionmentioning

confidence: 99%

Development of a Deep Learning System to Detect Esophageal Cancer by Barium Esophagram

et al. 2022

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BackgroundImplementation of deep learning systems (DLSs) for analysis of barium esophagram, a cost-effective diagnostic test for esophageal cancer detection, is expected to reduce the burden to radiologists while ensuring the accuracy of diagnosis.ObjectiveTo develop an automated DLS to detect esophageal cancer on barium esophagram.MethodsThis was a retrospective study using deep learning for esophageal cancer detection. A two-stage DLS (including a Selection network and a Classification network) was developed. Five datasets based on barium esophagram were used for stepwise training, validation, and testing of the DLS. Datasets 1 and 2 were used to respectively train and test the Selection network, while Datasets 3, 4, and 5 were respectively used to train, validate, and test the Classification network. Finally, a positioning box with a probability value was outputted by the DLS. A region of interest delineated by experienced radiologists was selected as the ground truth to evaluate the detection and classification efficiency of the DLS. Standard machine learning metrics (accuracy, recall, precision, sensitivity, and specificity) were calculated. A comparison with the conventional visual inspection approach was also conducted.ResultsThe accuracy, sensitivity, and specificity of our DLS in detecting esophageal cancer were 90.3%, 92.5%, and 88.7%, respectively. With the aid of DLS, the radiologists’ interpretation time was significantly shortened (Reader1, 45.7 s vs. 72.2 s without DLS aid; Reader2, 54.1 s vs. 108.7 s without DLS aid). Respective diagnostic efficiencies for Reader1 with and without DLS aid were 96.8% vs. 89.3% for accuracy, 97.5% vs. 87.5% for sensitivity, 96.2% vs. 90.6% for specificity, and 0.969 vs. 0.890 for AUC. Respective diagnostic efficiencies for Reader2 with and without DLS aid were 95.7% vs. 88.2% for accuracy, 92.5% vs. 77.5% for sensitivity, 98.1% vs. 96.2% for specificity, and 0.953 vs. 0.869 for AUC. Of note, the positioning boxes outputted by the DLS almost overlapped with those manually labeled by the radiologists on Dataset 5.ConclusionsThe proposed two-stage DLS for detecting esophageal cancer on barium esophagram could effectively shorten the interpretation time with an excellent diagnostic performance. It may well assist radiologists in clinical practice to reduce their burden.

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Clinical Success and Correlation of Eckardt Scores with Barium Esophagram After Peroral Endoscopic Myotomy in Achalasia

Cited by 5 publications

References 5 publications

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

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

Submucosal endoscopy: the present and future

Development of a Deep Learning System to Detect Esophageal Cancer by Barium Esophagram

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