435 Trends and Correlation Between Eckardt Scores and Timed Barium Esophagram Parameters After Per-Oral Endoscopic Myotomy in Achalasia

Abstract

INTRODUCTION: Symptomatic relief by Eckardt scores is used to assess treatment success after per-oral endoscopic myotomy (POEM). However, it is unclear if symptomatic improvement correlates with objective esophageal emptying on timed barium esophagram (TBE). Hence, our study aims were to identify the trends and correlation between Eckardt scores and TBE parameters after POEM. METHODS: Medical records of all achalasia patients who underwent POEM at our institution between April 2014 and May 2019 were reviewed. Patients who underwent timed barium esophagram (TBE) and high-resolution esophageal manometry (HREM) prior to POEM along with two-month post-POEM, TBE and HREM were included. Demographics and procedural details, TBE, HREM and Eckardt scores were reviewed. Post-POEM Eckhardt score of ≤3 was considered as successful palliation of symptoms. Trends in Eckardt scores and TBE parameters were identified and their association was analyzed. Statistical tests were performed using linear mixed effects and longitudinal modeling. RESULTS: A total of 219 patients underwent POEM with a median follow up duration of 2.6 months [Q1-3: 2.2 to 13.7 months]. Baseline patient characteristics and outcomes are described in Table 1. Improvement in Eckardt scores was stable over 24 months, however symptoms were lowest at 3-6 months after POEM (Figure 1a). TBE width at 1 and 5 minutes were lowest at 6-9 months after POEM, however TBE width gradually returns to baseline around 18-21 months even becoming worse than baseline levels (Figure 1b,c). Lower esophageal sphincter-Integrated relaxation pressure (LES-IRP) improvement was stable over 15 months, however this parameter was limited by number of patients undergoing follow up testing (n = 62). BMI increases slightly but remains around baseline for 24 months (Figure 1d). Among the 4 TBE parameters assessed, Eckardt scores correlates the most with barium column width at 5 minutes and the degree of correlation is moderate (Figure 2). CONCLUSION: Although patients continue to have symptomatic relief after POEM, objective parameters of esophageal emptying on TBE return to pre-operative levels or even worsen around two years after POEM. Eckardt scores correlate the most with barium column width at 5-minutes on TBE. Our findings suggest that barium column width at 5 minutes on TBE might be a useful objective marker for treatment response in the mid to long-term follow up after POEM.