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

Autor: DeWitt JM; Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United States., Siwiec RM; Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United States., Perkins A; Department of Biostatistics, Indiana University Health Medical Center, Indianapolis, Indiana, United States., Baik D; Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United States., Kessler WR; Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United States., Nowak TV; Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United States., Wo JM; Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United States., James-Stevenson T; Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United States., Mendez M; Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United States., Dickson D; Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United States., Stainko S; Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United States., Akisik F; Department of Radiology, Indiana University Health Medical Center, Indianapolis, Indiana, United States., Lappas J; Department of Radiology, Indiana University Health Medical Center, Indianapolis, Indiana, United States., Al-Haddad MA; Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, United States.
Jazyk: angličtina
Zdroj: Endoscopy international open [Endosc Int Open] 2021 Nov 12; Vol. 9 (11), pp. E1692-E1701. Date of Electronic Publication: 2021 Nov 12 (Print Publication: 2021).
DOI: 10.1055/a-1546-8415
Abstrakt: 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 mm 2 /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.
Competing Interests: Competing interests Dr. DeWitt is a consultant for Boston Scientific, Inc. Dr. Al-Haddad is a consultant for Boston Scientific Inc.
(The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)
Databáze: MEDLINE
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