Timed barium oesophagram: better predictor of long term success after pneumatic dilation in achalasia than symptom assessment

Abstract

Background: Symptom relief post pneumatic dilation is traditionally used to assess treatment success in achalasia patients. Recently, we showed that symptom relief and objective oesophageal emptying are concordant in about 70% of patients, while up to 30% of achalasia patients report near complete symptom relief despite poor oesophageal emptying of barium. Aims: We now report the results of long term clinical follow up in these two groups of achalasia patients, assessing differences in symptomatic remission rates. Methods: Achalasia patients undergoing pneumatic dilation since 1995 were evaluated both symptomatically and objectively at regular intervals. Pre and post dilation symptoms were recorded. Barium column height was measured five minutes after ingesting a fixed volume of barium per patient to assess oesophageal emptying. Patients who initially reported near complete symptom relief were divided into two groups based on objective findings on barium study: (1) complete oesophageal emptying (concordant group), and (2) poor oesophageal emptying (discordant group). Patients were followed prospectively for symptom recurrence. Results: Thirty four patients with complete symptom relief post pneumatic dilation were identified. In 22/34 (65%) patients, the degree of symptom and barium height improvements was similar (concordant group). In 10/34 (30%) patients, there was < 50% improvement in barium height (discordant group). Significantly (p<0.001) more discordant (9/10; 90%) than concordant (2/22; 9%) patients failed therapy at the one year follow up. Seventeen of 22 (77%) concordant patients were still in remission while all discordant patients had failed therapy by six years of follow up. Length of time in symptom remission (mean (SEM)) post pneumatic dilation was significantly (p=0.001) less for the discordant group (18.0 (3.6) months) compared with the concordant group (59.0 (4.8) months). Conclusions: (1) Poor oesophageal emptying is present in nearly 30% of achalasia patients reporting complete symptom relief post pneumatic dilation. (2) The majority (90%) of these patients will fail within one year of treatment. (3) Timed barium oesophagram is an important tool in the objective evaluation of achalasia patients post pneumatic dilation.

Description of the technique of upper gastrointestinal series radiological examination for the evaluation of the esophagus, stomach and duodenum of Wistar female rats

“…In the post-operative procedures of stomach and esophagus surgeries, it is possible to search for secondary deformities that appear after the surgical procedures, exactly when the trauma will not be surgical the esophagography may have sensitivity varying of 50-90% of the times [13][14][15][16] .…”

Per Oral Endoscopic Myotomy in Children with Achalasia Cardia

“…Each of the endoscopist performing POEM in children had prior experience of at least 20 adult cases. Achalasia cardia was diagnosed with standard diagnostic modalities including timed barium esophagogram (TBE) 7 , high-resolution manometry (HRM) and esophagogastroduodenoscopy (EGD) in all the children. Children with contraindications to undergo general anaesthesia or whose parents did not give consent for the procedure were excluded from this study.…”

High Resolution Manometry - A Mandatory Examination in the Pre and Postoperative Assessment of Patients with Achalasia

“…The classical appearance of achalasia on Barium studies is with "bird beak" aspect of EGJ, varying degrees of esophageal dilation up to sigmoid esophagus, an air-fluid level or absence of the gastric air bubble (23).…”

“…Barium esophagram and endoscopy are only complementary tests, and in early stages, these may be completely normal (18,23).…”

“…Predictors of the best clinical outcomes after PD include: age older than 40 years, women, LES pressure after dilatation <10 mmHg and type II pattern by HRM (14,23,45,46).…”