Unit of Gastrointestinal Motility, Medical School, University of Crete, Crete, Greece.
Dis Esophagus. 2011 Sep;24(7):451-7. doi: 10.1111/j.1442-2050.2011.01178.x. Epub 2011 Mar 8.
Esophageal emptying assessed at the 'timed barium' esophagogram correlates well with symptomatic outcomes after pneumatic dilation for esophageal achalasia, although 30% of patients with satisfactory outcome exhibit partial improvement in emptying. The aim of the study was to investigate any correlation of esophageal emptying to symptomatic response after laparoscopic Heller's myotomy and Dor's fundoplication. 'Bread and barium' (transit time of a barium opaque bread bolus) and 'timed barium' (height of esophageal barium column 5 minutes after ingestion of 200-250 mL of barium suspension) esophagogram was used to assess esophageal emptying in 73 patients with esophageal achalasia before 1 and 5 years (31 cases) after laparoscopic myotomy and anterior fundoplication. Symptoms assessment was based to a specific score. At 1-year follow-up, excellent and good symptomatic results were obtained in 95% of the cases. Esophageal maximum diameter, esophageal transit time, and esophageal barium column were significantly correlated to each other and to symptom score postoperatively (P < 0.001). Complete and partial (<90% and 50-90% postoperative reduction in barium column, respectively) emptying was seen in 55% and 31% of patients with excellent result. Patients with a pseudodiverticulum postoperatively had a more delayed esophageal emptying than those without. Symptomatic outcome and esophageal emptying did not deteriorate at 5-year follow-up. Esophageal emptying assessed by 'barium and bread' and 'timed barium' esophagogram correlated well with symptomatic outcome after laparoscopic myotomy for esophageal achalasia. Complete symptomatic relief does not necessarily reflect complete esophageal emptying. Outcomes do not deteriorate by time. Because of wide availability, esophagogram can be applied in follow-up of postmyotomy patients in conjunction with symptomatic evaluation.
食管排空在“计时钡”食管造影中评估与食管失弛缓症经气动扩张后的症状结果密切相关，尽管 30%的症状改善满意的患者显示排空有部分改善。本研究旨在探讨食管排空与腹腔镜 Heller 肌切开术和 Dor 胃底折叠术治疗后症状反应的相关性。在 73 例食管失弛缓症患者中，使用“面包和钡”（钡不透明面包丸通过时间）和“计时钡”（吞咽 200-250 毫升钡混悬液后 5 分钟食管钡柱高度）食管造影术在腹腔镜肌切开术和前胃底折叠术前 1 年和 5 年（31 例）时评估食管排空。症状评估基于特定评分。在 1 年随访时，95%的病例获得了极好和良好的症状结果。食管最大直径、食管通过时间和食管钡柱在术后与症状评分显著相关（P < 0.001）。在获得极好结果的患者中，分别有 55%和 31%的患者完全排空（排空率<90%）和部分排空（排空率为 50-90%）。术后有假性憩室的患者食管排空时间较无假性憩室者延迟。在 5 年随访时，症状结果和食管排空没有恶化。通过“钡和面包”和“计时钡”食管造影术评估的食管排空与腹腔镜肌切开术治疗食管失弛缓症后的症状结果密切相关。完全缓解症状并不一定反映完全排空。结果不会随时间恶化。由于广泛应用，食管造影术可与症状评估一起应用于肌切开术后患者的随访。
