Clinical Success and Correlation of Eckardt Scores with Barium Esophagram After Peroral Endoscopic Myotomy in Achalasia
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RESEARCH COMMUNICATION
Clinical Success and Correlation of Eckardt Scores with Barium Esophagram After Peroral Endoscopic Myotomy in Achalasia Madhusudan R. Sanaka 1 & Pravallika Chadalavada 2 & Fahrettin Covut 2 & George Khoudari 2 & Scott Gabbard 1 & Prashanthi N. Thota 1 & Siva Raja 3 Received: 14 May 2020 / Accepted: 19 July 2020 # 2020 The Society for Surgery of the Alimentary Tract
Keywords Achalasia . Myotomy . Peroral endoscopic myotomy (POEM) . Timed barium esophagram . Eckardt score
Introduction There is scarcity of data on clinical improvement and correlation with objective esophageal function after peroral endoscopic myotomy (POEM) in achalasia. We aimed to determine the trends and correlation between Eckardt scores and TBE parameters during follow-up after POEM.
Eckardt score to < 3. Patients with prior failed Heller myotomy were excluded. The Pearson correlation coefficients were used to determine the degree of correlation between 1 changes in TBE parameters and Eckardt scores. All comparisons were two sided.
Results Materials and Methods We conducted a retrospective review of all achalasia patients who underwent POEM at our institution between April 2014 and May 2019. Clinical success was defined as a reduction of
Madhusudan R. Sanaka and Pravallika Chadalavada are co-first authors. * Madhusudan R. Sanaka [email protected] 1
Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
2
Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
3
Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
A total of 170 patients were analyzed. Patient demographics and baseline clinical characteristics are summarized in Table 1. Changes in Eckardt scores and TBE parameters after POEM at each of the follow-up evaluations are shown in Table 2. The correlation coefficient between post-POEM changes in Eckardt score and barium column height at 1 min, height at 5 min, width at 1 min, and width at 5 min on TBE was 0.044 (95% CI: − 0.080 to 0.168, p = 0.48), 0.062 (95% CI: − 0.063 to 0.184, p = 0.33), 0.205 (95% CI: 0.083–0.321, p = 0.001), and 0.140 (95% CI: 0.016–0.260, p = 0.027), respectively. During the follow-up period after POEM, proportion of patients with clinical success was 99.3% (95% CI: 97.8–100) at 2 months, 92.1% (95% CI: 86.9– 97.6) at 1 year, 88.8% (95% CI: 82.2–95.9) at 2 years, 74.9% (95% CI: 63.1–88.9) at 3 years, and 74.9% (95% CI: 63.1–88.9) at 4 years, respectively. Rates of abnormal pH study and GERD symptoms are shown in Table 2.
J Gastrointest Surg Table 1 Patient demographics and clinical characteristics
Characteristics
All patients N [%]
Number of patients Age at POEM, year Male gender Caucasian ethnicity Body mass index, kg/m2 ASA class I II III IV Achalasia type I II III Unclassified Timed barium esophagram Column Height at 1 min, cm Column Height at 5 min, cm Column Width at
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