ECR 2018 / C-0394
Efficacy of Peroral Endoscopic Myotomy for Achalasia: Evaluation of Treatment Effect using Timed Barium Esophagography according to the Diameter of Lower Esophageal Sphincter
Keywords:
Gastrointestinal tract, Fluoroscopy, Digital radiography, Barium meal, Dynamic swallowing studies, Treatment effects, Motility
Authors:
J.-J. Chung, J. H. Kim, E.-S. Cho, J.-S. Yu; Seoul/KR
DOI:
10.1594/ecr2018/C-0394
Methods and materials
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TBE is performed in the erect posture under fluoroscopy.
A low density barium sulphate suspension (45% weight by volume) is ingested orally within 15-20 seconds.
The volume of suspension (usually 100 to 250 mL) should be such that patient can tolerate it well without regurgitation or aspiration and the dilated achalasic esophagus can be filled adequately.
It is better to have a fixed volume as a standard protocol.
Erect anterior posterior,
left anterior and posterior oblique images are taken 1,
2 and 5 minutes after barium ingestion.
For sequential studies before and after POEM for achalasia,
one should consume the same volume of barium as ingested for the baseline examination to have consistent results.
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A total of 32 patients (M:F=20:12,
mean age: 43 years-old) underwent pre- and post-POEM TBE for achalasia confirmed by manometry,
who were divided into 3 groups according to LES diameter (A: less than 5 mm,
B: 5 to 8 mm,
C: more than 8 mm).
The increased value of LES after POEM were measured in each group for comparison of treatment effect.
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Esophageal shape (bird’s beak [n=24],
diffuse narrowing [n=4],
tortuous [n=2],
sigmoid [n=2]) on pre-POEM TBE,
Eckardt score,
and history of pre-POEM pneumatic dilatation were also compared in each group.
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All data were statistically analyzed using Kruskall-Wallis test (esophageal shape),
Mann-Whitney U test (LES diameter group,
prior pneumatic dilatation),
or simple correlation (Eckardt score).