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...

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Autores principales:	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
Formato:	article
Lenguaje:	EN
Publicado:	Georg Thieme Verlag KG 2021
Materias:	Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/1da8edc5fc824bb59ae29a359cfb58ed
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spelling	oai:doaj.org-article:1da8edc5fc824bb59ae29a359cfb58ed2021-11-13T00:00:31ZEvaluation of timed barium esophagram after per-oral endoscopic myotomy to predict clinical response2364-37222196-973610.1055/a-1546-8415https://doaj.org/article/1da8edc5fc824bb59ae29a359cfb58ed2021-11-01T00:00:00Zhttp://www.thieme-connect.de/DOI/DOI?10.1055/a-1546-8415https://doaj.org/toc/2364-3722https://doaj.org/toc/2196-9736Background 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.John M. DeWittRobert M. SiwiecAnthony PerkinsDaniel BaikWilliam R. KesslerThomas V. NowakJohn M. WoToyia James-StevensonMartha MendezDestenee DicksonSarah StainkoFatih AkisikJohn LappasMohammad A. Al-HaddadGeorg Thieme Verlag KGarticleDiseases of the digestive system. GastroenterologyRC799-869ENEndoscopy International Open, Vol 09, Iss 11, Pp E1692-E1701 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	Diseases of the digestive system. Gastroenterology RC799-869 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
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.
format	article
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
title	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_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_sort	evaluation of timed barium esophagram after per-oral endoscopic myotomy to predict clinical response
publisher	Georg Thieme Verlag KG
publishDate	2021
url	https://doaj.org/article/1da8edc5fc824bb59ae29a359cfb58ed
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Evaluation of timed barium esophagram after per-oral endoscopic myotomy to predict clinical response

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