Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Timed barium esophagography to predict recurrent achalasia after peroral endoscopic myotomy: a retrospective study in Thailand

  • Tharathorn Suwatthanarak (Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Chainarong Phalanusitthepa (Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Chatbadin Thongchuam (Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Thawatchai Akaraviputh (Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Vitoon Chinswangwatanakul (Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Thikhamporn Tawantanakorn (Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Somchai Leelakusolvong (Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Monthira Maneerattanaporn (Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Piyaporn Apisarnthanarak (Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Jitladda Wasinrat (Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University)
  • Received : 2023.09.23
  • Accepted : 2024.01.31
  • Published : 2024.09.30
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Abstract

Background/Aims: Achalasia is a rare esophageal motility disease, for which peroral endoscopic myotomy (POEM) has emerged as a promising treatment option; however, recurrence remains a challenge. Timed barium esophagography (TBE) is a useful diagnostic tool and potential outcome predictor of achalasia. This study aimed to determine predictive tools for recurrence after POEM. Methods: This retrospective study enrolled achalasia patients who underwent POEM between January 2015 and December 2021. Patients were categorized into two groups using the 1-month post-POEM Eckardt scores and TBE: the discordant group (Eckardt score improved >50%, TBE decreased <50%) and the concordant group (both Eckardt score and TBE improved >50%). Recurrence was defined as a reincrease in the Eckardt score to more than three during follow-up. Results: Complete medical records were available in 30 patients who underwent POEM. Seventeen patients (56.7%) were classified into the discordant group, while 13 patients (43.3%) were in the concordant group. The overall recurrence rate was 11.9% at 1-year, increasing to 23.8% during the extended follow-up. The discordant group had a 6.87 fold higher recurrence rate than the concordant group (52.9% vs. 7.7%, p=0.017). Conclusions: These results strongly suggest that combining the Eckardt score with TBE can effectively predict recurrent achalasia after POEM. Patients in the discordant group had an elevated risk.

Keywords

Acknowledgement

The authors would like to express their thanks to Dr. Saowalak Hunnangkul for the statistical consultation and Dr. Mark Simmerman for assistance in editing the English version of this manuscript.

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