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Background <p>Peroral endoscopic myotomy (POEM) is an increasingly utilized endoscopic therapy for achalasia. When undergoing esophagogastroduodenoscopy (EGD), patients with a diagnosis of achalasia may receive endotracheal intubation (EI) to reduce the risk of aspiration. The risk of aspiration on post-POEM EGD should be reduced due to improved esophageal emptying. Despite history of myotomy, treated achalasia patients frequently receive EI on follow-up EGD increasing costs, procedural time, and potential risks from anesthesia. We determined if timed barium esophagram (TBE) findings three to six months after POEM predict the presence of esophageal contents on follow up endoscopy which may indicate aspiration risk.</p> Methods <p>We identified achalasia patients who underwent POEM from September 2021 to October 2023 and had both a follow-up TBE and EGD three to six months later. At our institution, all achalasia patients are instructed to avoid solid oral intake (liquids allowed) for 2 days prior to pre-and post-POEM EGD. Predictors of esophageal contents were identified and receiver operating characteristic (ROC) curves were constructed to determine column heights that correspond to the presence of esophageal contents.</p> Results <p>We identified 48 patients meeting inclusion criteria. Increasing barium column height at 5&#xa0;min was associated with liquid/solid esophageal contents on EGD (OR: 1.36; <i>p</i> = 0.004). The receiver operating characteristics curve for esophageal contents demonstrated an area under the curve of 0.85 at 7&#xa0;cm. Passage of a 13&#xa0;mm tablet was inversely associated with the presence of esophageal contents (OR: 0.03; <i>p</i> = 0.002).</p> Conclusion <p>In post-POEM achalasia patients, follow-up TBE at 3–6 months demonstrating a 5-minute barium column height of less than 7.0&#xa0;cm and passage of a 13&#xa0;mm barium tablet may predict an esophagus free of liquid/solids during follow-up EGD after a 2-day solid fast. This study adds to our knowledge that TBE findings are a good predictor of esophageal emptying post-POEM, and may be used to predict which patients may be at risk of having residual esophageal contents and therefore need EI.</p>

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Three-to-six month post-POEM timed barium esophagram can predict esophageal contents and may stratify aspiration risk on follow-up EGD

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  • 发表日期：

    2025年4月12日

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  • Julia D. Liberto,
  • Ross Dierkhising,
  • Diana L. Snyder,
  • Karthik Ravi,
  • Jeffrey A. Alexander,
  • D. Chamil Codipilly

摘要

Background

Peroral endoscopic myotomy (POEM) is an increasingly utilized endoscopic therapy for achalasia. When undergoing esophagogastroduodenoscopy (EGD), patients with a diagnosis of achalasia may receive endotracheal intubation (EI) to reduce the risk of aspiration. The risk of aspiration on post-POEM EGD should be reduced due to improved esophageal emptying. Despite history of myotomy, treated achalasia patients frequently receive EI on follow-up EGD increasing costs, procedural time, and potential risks from anesthesia. We determined if timed barium esophagram (TBE) findings three to six months after POEM predict the presence of esophageal contents on follow up endoscopy which may indicate aspiration risk.

Methods

We identified achalasia patients who underwent POEM from September 2021 to October 2023 and had both a follow-up TBE and EGD three to six months later. At our institution, all achalasia patients are instructed to avoid solid oral intake (liquids allowed) for 2 days prior to pre-and post-POEM EGD. Predictors of esophageal contents were identified and receiver operating characteristic (ROC) curves were constructed to determine column heights that correspond to the presence of esophageal contents.

Results

We identified 48 patients meeting inclusion criteria. Increasing barium column height at 5 min was associated with liquid/solid esophageal contents on EGD (OR: 1.36; p = 0.004). The receiver operating characteristics curve for esophageal contents demonstrated an area under the curve of 0.85 at 7 cm. Passage of a 13 mm tablet was inversely associated with the presence of esophageal contents (OR: 0.03; p = 0.002).

Conclusion

In post-POEM achalasia patients, follow-up TBE at 3–6 months demonstrating a 5-minute barium column height of less than 7.0 cm and passage of a 13 mm barium tablet may predict an esophagus free of liquid/solids during follow-up EGD after a 2-day solid fast. This study adds to our knowledge that TBE findings are a good predictor of esophageal emptying post-POEM, and may be used to predict which patients may be at risk of having residual esophageal contents and therefore need EI.