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

Publisher: BioMed Central Country of Publication: England NLM ID: 100968547 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-230X (Electronic) Linking ISSN: 1471230X NLM ISO Abbreviation: BMC Gastroenterol Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Esophageal Achalasia*/surgery ; Esophageal Achalasia*/diagnostic imaging ; Endoscopy, Digestive System*/methods ; Myotomy*/methods ; Esophagus*/diagnostic imaging ; Respiratory Aspiration*/etiology ; Respiratory Aspiration*/prevention & control; Humans ; Male ; Female ; Middle Aged ; Adult ; Aged ; Time Factors ; Follow-Up Studies ; Barium Sulfate ; Risk Assessment ; Intubation, Intratracheal ; Retrospective Studies ; Predictive Value of Tests ; Barium

Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Institutional Review Board at Mayo Clinic, Rochester, USA on February 19, 2024 (IRB#: 24-001338). All subjects within the study provided informed consent for inclusion in this study. All testing/experiments done on tissue samples during this study were performed in accordance with relevant guidelines and regulations as set forth by the Mayo Clinic Institutional Review Board. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.
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.
(© 2025. The Author(s).)

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Hugh Butt Fellowship Award Mayo Clinic Division of Gastroenterology and Hepatology; Hugh Butt Fellowship Award Mayo Clinic Division of Gastroenterology and Hepatology; Hugh Butt Fellowship Award Mayo Clinic Division of Gastroenterology and Hepatology; Hugh Butt Fellowship Award Mayo Clinic Division of Gastroenterology and Hepatology; Hugh Butt Fellowship Award Mayo Clinic Division of Gastroenterology and Hepatology; Hugh Butt Fellowship Award Mayo Clinic Division of Gastroenterology and Hepatology

Keywords: Achalasia; Esophageal dysmotility; Peroral endoscopic myotomy; Timed barium esophagram

25BB7EKE2E (Barium Sulfate)
24GP945V5T (Barium)

Date Created: 20250412 Date Completed: 20250412 Latest Revision: 20250415

20250415

PMC11993974

10.1186/s12876-025-03838-7

40221687