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Timed barium esophagogram: A simple physiologic assessment for achalasia
S V Kostic1, T W Rice, M E Baker
1Center for Swallowing and Esophageal Disorders, Departments of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA.
The Journal of Thoracic and Cardiovascular Surgery
|October 24, 2000
Summary
Timed barium esophagography objectively confirms achalasia myotomy success. Patient symptoms are unreliable for assessing esophageal emptying after surgery.
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Diagnostic Imaging
Background:
- Assessing achalasia therapy success is challenging due to subjective symptoms and impracticality of repeated physiologic studies.
- Timed barium esophagography offers a direct, simple method to measure esophageal emptying.
Purpose of the Study:
- To evaluate timed barium esophagography (TBE) for assessing myotomy outcomes in achalasia.
- To compare TBE findings with pre- and post-myotomy patient symptoms.
Main Methods:
- Fifty patients underwent premyotomy TBE with 250 mL low-density barium and upright films at 1, 2, and 5 minutes.
- Forty-five patients had repeat TBE 8 weeks postmyotomy.
- Premyotomy and postmyotomy barium column height and width were analyzed and correlated with symptoms.
Main Results:
- Myotomy significantly reduced barium column height and width (P <.001).
- Complete esophageal emptying postmyotomy was observed in 29-49% of patients.
- Postmyotomy symptoms were not reliably correlated with TBE results, though premyotomy symptoms showed some correlations with esophageal emptying parameters.
Conclusions:
- Timed barium esophagography provides objective confirmation of successful achalasia myotomy.
- Patient-reported symptoms are unreliable for assessing post-myotomy esophageal emptying.