SAN ANTONIO – Roughly 2 years postsurgery, objective parameters for esophageal emptying, as measured by timed barium esophagram in patients who received per-oral endoscopic myotomy in achalasia, returned to presurgery levels, or were worse, according to study results presented at the American College of Gastroenterology 2019 Annual Scientific Meeting held October 25-30 in San Antonio, Texas.

Eckardt scores of symptomatic relief are used to evaluate treatment success after per-oral endoscopic myotomy. However, there is not an established correlation between objective improvement of esophageal emptying, as measured by timed barium esophagram, and such report of symptomatic relief. Therefore, researchers conducted an extensive medical record review of all patients who received per-oral endoscopic myotomy between April 2014 to May 2019 at one medical center. Inclusion criteria also required results of a tuned barium esophagram and high-resolution esophageal manometry before myotomy, as well as scores from all 3 parameters at 2 months postprocedure.

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A total of 219 patients, with a median age of 61.09 years, were included in the study cohort. The majority of patients had a diagnosis of stage 2 achalasia (51.6%), followed by stage 1 (31.6%). Further, the majority of patients also had a history of prior procedures to treat their illness: 22.4% of patients received a Heller myotomy, 21.5% received a botox injection, and 14.2% had a pneumatic dilation.


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Results demonstrated that although Eckardt scores were stable over a period of 24 months, the lowest scores were most common at the period of 3 to 6 months postmyotomy. Measurements of esophageal width at 1 and 5 minutes on timed barium esophagram were lowest at 6 to 9 months postmyotomy, and there was a return to baseline at approximately 18 to 21 months postprocedure. Moreover, a significant number of patients had scores below baseline. Results also showed that of the 4 parameters assessed on timed barium esophagram, Eckardt scores correlated the most with barium column width at 5 minutes, and the degree of correlation was moderate.

Researchers concluded that because Eckardt scores correlated with 5-minute width findings on timed barium esophagram, the results of this latter assessment may be a “useful objective marker for treatment response in the mid to long-term follow up after [per-oral esophageal manometry].

Reference

Sanaka MR, Parikh MP, Tang A, et al. Trends and correlation between Eckardt scores and timed barium esophagram parameters after per-oral endoscopic myotomy in achalasia. Presented at: American College of Gastroenterology 2019 Annual Scientific Meeting; October 25-30, 2019; San Antonio, TX. Poster P2077.