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J Thorac Cardiovasc Surg 2000;120:935-946
© 2000 The American Association for Thoracic Surgery
General Thoracic Surgery |
From the Center for Swallowing and Esophageal Disorders, Departments of Thoracic and Cardiovascular Surgery,a Radiology,b Biostatistics and Epidemiology,c and Gastroenterology,d The Cleveland Clinic Foundation, Cleveland, Ohio.
Received for publication April 7, 2000 revisions requested June 20, 2000; revisions received July 18, 2000. Accepted for publication July 26, 2000. Address for reprints: Thomas W. Rice, MD, The Cleveland Clinic Foundation, 9500 Euclid Ave, Desk F25, Cleveland, OH 44195 (E-mail: ricet{at}ccf.org).
Abstract
Objective: Success of achalasia therapy is difficult to determine because repeated physiologic study is impractical and symptoms are subjective. Timed barium esophagography directly measures esophageal emptying and is simple to perform. This study (1) evaluates the assessment of myotomy by timed barium esophagography and (2) compares it with premyotomy and postmyotomy symptoms.
Methods: Fifty patients ingested 250 mL low-density barium and had upright films at 1, 2, and 5 minutes premyotomy. Forty-five underwent repeat timed barium esophagography 8 weeks (median) postmyotomy. Premyotomy and postmyotomy height and width of the barium column were compared and related to symptoms.
Results: At 1, 2, and 5 minutes premyotomy, median barium column height was 19, 17, and 15 cm, and width was 5.2, 4.8, and 4.5 cm, respectively. Surgery reduced these to 7.0, 5.0, and 1.0 cm and to 3.5, 3.0, and 1.0 cm, respectively (P < .001). Postmyotomy complete esophageal emptying was seen in 29%, 36%, and 49% at 1, 2, and 5 minutes. Postmyotomy height was unrelated (r ~ 0.2) to premyotomy height but was directly related to premyotomy width (r = 0.3-0.5; P < .05); postmyotomy width was directly related to premyotomy width (r ~ 0.6; P < .001). Premyotomy dysphagia was more severe when little change in width occurred from 1 to 5 minutes (r = 0.26, P = .07). Premyotomy regurgitation was more severe the higher the barium column (r ~ 0.4, P < .007). Surgery relieved symptoms in the majority of patients (grade 2-5 dysphagia from 72% to 4%, grade 2-5 regurgitation from 79% to 4%). Postmyotomy symptoms were unrelated to the timed barium esophagogram.
Conclusions: (1) The timed barium esophagogram gives objective confirmation of successful myotomy. (2) Symptoms are unreliable in assessing esophageal emptying.
This article has been cited by other articles:
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  B. C. ALLEN, M. E. BAKER, and G. W. FALK Role of barium esophagography in evaluating dysphagia Cleveland Clinic Journal of Medicine, February 1, 2009; 76(2): 105 - 111. [Abstract] [Full Text] [PDF]
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 M. E. Baker, D. M. Einstein, B. R. Herts, E. M. Remer, G. A. Motta-Ramirez, E. Ehrenwald, T. W. Rice, and J. E. Richter Gastroesophageal Reflux Disease: Integrating the Barium Esophagram before and after Antireflux Surgery Radiology, May 1, 2007; 243(2): 329 - 339. [Abstract] [Full Text] [PDF]
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 T. W. Rice, A. A. McKelvey, J. E. Richter, M. E. Baker, M. F. Vaezi, J. Feng, S. C. Murthy, D. P. Mason, and E. H. Blackstone A physiologic clinical study of achalasia: Should Dor fundoplication be added to Heller myotomy? J. Thorac. Cardiovasc. Surg., December 1, 2005; 130(6): 1593 - 1600. [Abstract] [Full Text] [PDF]
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