DeWitt, John M.Siwiec, Robert M.Perkins, AnthonyBaik, DanielKessler, William R.Nowak, Thomas V.Wo, John M.James-Stevenson, ToyiaMendez, MarthaDickson, DesteneeStainko, SarahAkisik, FatihLappas, JohnAl-Haddad, Mohammad A.2023-03-312023-03-312021-11-12DeWitt JM, Siwiec RM, Perkins A, et al. Evaluation of timed barium esophagram after per-oral endoscopic myotomy to predict clinical response. Endosc Int Open. 2021;9(11):E1692-E1701. Published 2021 Nov 12. doi:10.1055/a-1546-8415https://hdl.handle.net/1805/32155Background and study aims: The aim of this study was to evaluate whether timed barium esophagram within 24 hours post-per-oral endoscopic myotomy (POEM) (TBE-PP) could predict clinical outcomes. Patients and methods: This was a single-center retrospective study of prospectively collected data on consecutive patients with ≥ 6-month follow-up who underwent POEM followed by TBE-PP. Esophageal contrast retention 2 minutes after TBE-PP was assessed as Grade 1 (< 10 %), 2 (10 %-49 %), 3 (50 %-89 %) or 4 (> 90 %). Eckardt score, esophagogastroduodenoscopy (EGD), high-resolution manometry (HRM) and function lumen imaging probe (FLIP) of the esophagogastric junction (EGJ) were obtained at baseline. These tests along with pH testing of antisecretory therapy were repeated 6 and 24 months after POEM. Clinical response by Eckardt score ≤ 3, EGJ-distensibility index (EGJ-DI) > 2.8 mm 2 /mm Hg, and integrated relaxation pressure (IRP) < 15 mm Hg and incidence of gastroesophageal reflux disease (GERD) were compared by transit time. Results: Of 181 patients (58 % male, mean 53 ± 17 yr), TBE-PP was classified as Grade 1 in 122 (67.4 %), Grade 2 in 41 (22.7 %), Grade 3 in 14 (7.7 %) and Grade 4 in 4 (2.2 %). At 6 months, overall clinical response by ES (91.7 %), IRP (86.6 %), EGJ-DI (95.7 %) and the diagnosis of GERD (68.6 %) was similar between Grade 1 and Grade 2-4 TBE-PP. At 24 months, Grade 1 had a higher frequency of a normal IRP compared to Grades 2-4 (95.7 % vs. 60 %, P = 0.021) but overall response by ES (91.2 %), EGJ-DI (92.3 %) and the diagnosis of GERD (74.3 %) were similar. Conclusions: Contrast emptying rate by esophagram after POEM has limited utility to predict clinical response or risk of post-procedure GERD.en-USAttribution-NonCommercial-NoDerivatives 4.0 InternationalTimed barium esophagramPost-per-oral endoscopic myotomyEsophagogastroduodenoscopyHigh-resolution manometryFunction lumen imaging probeEckardt scoreArticle