Timed Barium Research Articles

S608 An Evaluation and Comparison of Timed Barium Esophagram and EndoFLIP in Patients With Clinically Relevant EGJOO vs Normal Manometric Controls

S608 An Evaluation and Comparison of Timed Barium Esophagram and EndoFLIP in Patients With Clinically Relevant EGJOO vs Normal Manometric Controls

Beyond visualizing the bird beak: esophagram, timed barium esophagram and manometry in achalasia and its 3 subtypes.

Achalasia is a rare esophageal motility disorder characterized by lack of primary peristalsis and a poorly relaxing lower esophageal sphincter. This disease process can be examined several ways and these evaluations can offer complementary information. There are three manometric subtypes of achalasia, with differing appearances on esophagram. Differentiating them is clinically important, because treatment for the subtypes varies. Timed barium esophagram (TBE) is a simple test to quantitatively evaluate esophageal emptying. TBE can be used to diagnose achalasia and assess treatment response. Considerable variation in the TBE protocol exist in the literature. We propose a standardized approach for TBE to allow for comparison across institutions.

Timed barium esophagography to predict recurrent achalasia after peroral endoscopic myotomy: a retrospective study in Thailand.

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. 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. 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). 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.

Esophagogastric Junction Outflow Obstruction (EGJOO): A Manometric Phenomenon or Clinically Impactful Problem.

Esophagogastric junction outflow obstruction (EGJOO), defined manometrically by impaired esophagogastric junction relaxation (EGJ) with preserved peristalsis, can be artifactual, due to secondary etiologies (mechanical, medication-induced), or a true motility disorder. The purpose of this review is to go over the evolving approach to diagnosing and treating clinically relevant EGJOO. Timed barium esophagram (TBE) and the functional lumen imaging probe (FLIP) are useful to identify clinically relevant EGJOO that merits lower esophageal sphincter (LES) directed therapies. There are no randomized controlled trials evaluating EJGOO treatment. Uncontrolled trials show effectiveness for pneumatic dilation and peroral endoscopic myotomy to treat confirmed EGJOO; Botox and Heller myotomy may also be considered but data for confirmed EGJOO is more limited. Diagnosis of clinically relevant idiopathic EGJOO requires symptoms, exclusion of mechanical and medication-related etiologies, and confirmation of EGJ obstruction by TBE or FLIP. Botox LES injection has limited durability, it can be used in patients who are not candidates for other treatments. PD and POEM are effective in confirmed EGJOO, Heller myotomy may also be considered but data for confirmed EGJOO is limited. Randomized controlled trials are needed to clarify optimal management of EGJOO.

A Comparison of Functional Luminal Imaging Probe With High-resolution Manometry, Timed Barium Esophagram, and pH Impedance Testing to Evaluate Functional Luminal Imaging Probe's Diagnostic Capabilities.

The aims of this study are to determine the functional luminal imaging probe's (FLIP) diagnostic utility by comparing FLIP measurements with results from other esophageal evaluation standards. The FLIP is an esophageal evaluation technique performed at the time of endoscopy. Few studies have evaluated FLIP diagnostic capabilities compared with the established testing techniques, including high-resolution manometry (HRIM), time barium esophagram (TBE), and 24-hour impedance-pH monitoring. A retrospective review was performed for 413 preintervention patients who underwent FLIP testing during endoscopy. Data from HRIM, 24-hour pH monitoring, and TBE were compared. Abnormal Distensibility Index (DI) was associated with abnormal integrated relaxation pressure (IRP; P = 0.003). Average DI was higher in patients with abnormal IRP (>15 mm Hg) when a hiatal hernia was present (P = 0.025). The total agreement between correlated diagnoses from FLIP and HRIM was 33.5%. DI was not associated with acid exposure time on pH monitoring. Agreement between FLIP and TBE was 49% with a sensitivity of 98.1% and a specificity of 36.5%. A 60 mL distension had a significantly lower detection rate than 40 mL and 50 mL for active peristalsis and was unaffected by pressure (P < 0.05). FLIP as an adjunct to HRIM is supported by strong metric correlation. FLIP was not correlated to pH monitoring findings, suggesting FLIP is not useful in reflux assessment. The agreement between FLIP and TBE was lower than in previous studies. Hiatal hernia impacted the normality between DI and IRP, not between FLIP and TBE. We suggest analyzing peristaltic patterns on panometry at all fill volumes to optimize detection.

Efficacy of Peroral Endoscopic Myotomy for Achalasia: Evaluation of Treatment Effect using Timed Barium Esophagography

Peroral endoscopic myotomy (POEM) is one of the standard treatment modality for achalasia. This study was to evaluate the usefulness of timed barium esophagography (TBE) in the evaluation of treatment effect of POEM for achalasia. A total of 36 patients (M:F=22:14) underwent pre- and post-POEM TBE (3 groups according to lower esophageal sphincter (LES) caliber, A: &lt; 5 mm, B: 5~8 mm, C: &gt; 8 mm). On pre and post-POEM TBE, the rate of area changes of barium column and the changes of LES caliber were investigated. All data were statistically analyzed using the Kruskal-Wallis test or Mann-Whitney U test. The mean rate of area change of the barium column at 5 minutes between pre- and post-POEM TBE were -51.7%, -28.8% and -11.6% in group A (n=10), B (n=18), and C (n=8), respectively, statistically significant (p &lt; 0.001). The rate difference of the barium column area changes between group A and group B only showed the statistical significance (p &lt; 0.001). The mean increased caliber of LES after POEM was 5.5 mm, 2.9 mm, and 3.3 mm in group A, B, and C, respectively. Group A and bird’s beak type showed a statistically significant treatment effect (p &lt; 0.001). In conclusion, TBE was useful in the evaluation of the treatment effect of POEM for achalasia and the narrowest LES group and bird’s beak esophageal type on TBE showed statistically significant treatment effects.

S2266 Achalasia as a Sequelae of COVID-19

Introduction: Achalasia is a neurodegenerative motility disorder of distal esophagus and lower esophageal sphincter characterized by loss of myenteric neurons in esophagus. It therefore results in deranged peristalsis and characteristic manifestations of regurgitation, dysphagia and retrosternal chest pressure sensation. Recent studies have suggested inflammatory neurodegenerative insult from viral infection as a potential etiology. Sars-Cov-2 causes multiple gastrointestinal (GI) manifestations like ageusia, nausea, vomiting, pain and diarrhea. We present a rare case of achalasia that presented soon after COVID infection in an otherwise healthy male. Case Description/Methods: A 63-year-old man was referred for further evaluation of dysphagia that started a few months after a non-severe COVID infection with associated ageusia. He reported progressive dysphagia to both solids and liquids with concomitant regurgitation and chest pain. By the time he presented, he had lost 45 lbs over the course of 6 months and had an Eckardt score of 8. High resolution manometry was suggestive of evolving type II achalasia. A follow up Endoflip exam with a 16 cm catheter inflated to 60 cc revealed a esophagogastric diameter of 7.3 mm and a distensibility index (DI) of 1.9. Timed barium esophagogram showed a 5 cm contrast column in distal esophagus at 5 minutes. The patient has since been referred for per oral endoscopic myotomy (Figure). Discussion: Sars-Cov-2 enters the GI epithelial cells through ACE2 receptors and exerts its effects through an aberrant immune response involving T- lymphocytes rather than direct epithelial damage. An anomalous immune reaction resulting in degeneration of inhibitory neurons in the myenteric plexus may be the cause of achalasia in COVID-19. On literature review, we came across at least 1 case report of a patient developing achalasia after COVID-19. A Venezuelan study noted that the frequency of patients with achalasia during the year 2020 and 2021 was far greater than those of previous years and at least 2/3rd of these patients had presented with COVID-19 infection. It will be interesting to note if coronavirus can be isolated from muscle biopsies of these subjects as has been the case with VZV previously. Further investigation especially into patients presenting with GI symptoms with COVID infection is warranted.Figure 1.: Endoflip ; Barium Esophageogram.

Elevated average maximum intrabolus pressure on high-resolution manometry is associated with esophageal dysmotility and delayed esophageal emptying on timed barium esophagram

BackgroundIntrabolus pressure (IBP) recorded by high-resolution manometry (HRM) portrays the compartmentalized force on a bolus during esophageal peristalsis. HRM may be a reliable screening tool for esophageal dysmotility in patients with elevated average maximum IBP (AM-IBP). Timed barium esophagram (TBE) is a validated measure of esophageal emptying disorders, such as esophagogastric junction outflow obstruction and achalasia. This study aimed to determine if an elevated AM-IBP correlates with esophageal dysmotility on HRM and/or delayed esophageal emptying on TBE.MethodsA retrospective analysis of all HRM (unweighted sample n = 155) performed at a tertiary referral center from 09/2015–03/2017 yielded a case group (n = 114) with abnormal AM-IBP and a control group (n = 41) with a normal AM-IBP (pressure < 17 mmHg) as consistent with Chicago Classification 3. All patients received a standardized TBE, with abnormalities classified as greater than 1 cm of retained residual liquid barium in the esophagus at 1 and 5 min or as tablet retention after 5 min.ResultsAM-IBP was significantly related to liquid barium retention (p = 0.003) and tablet arrest on timed barium esophagram (p = 0.011). A logistic regression model correctly predicted tablet arrest in 63% of cases. Tablet arrest on AM-IBP correlated with an optimal prediction point at 20.1 mmHg on HRM. Patients with elevated AM-IBP were more likely to have underlying esophageal dysmotility (95.6% vs. 70.7% respectively; p < 0.001), particularly esophagogastric junction outflow obstruction disorders. Elevated AM-IBP was associated with incomplete liquid bolus transit on impedance analysis (p = 0.002).ConclusionsOur findings demonstrate that an elevated AM-IBP is associated with abnormal TBE findings of esophageal tablet retention and/or bolus stasis. An abnormal AM-IBP (greater than 20.1 mm Hg) was associated with a higher probability of retaining liquid bolus or barium tablet arrest on TBE and esophageal dysmotility on HRM. This finding supports the recent incorporation of IBP in Chicago Classification v4.0.

Timed barium swallow: Esophageal stasis varies markedly across subtypes of esophagogastric junction obstruction.

Timed barium swallow (TBS) is a recommended ancillary investigation in evaluation of esophagogastric junction (EGJ) obstruction, yet there are little data comparing esophageal stasis across subtypes. A retrospective cohort study was performed. All type III achalasia diagnosed between November 2016 and November 2020 were included, along with matched numbers of consecutive types I and II and conclusive EGJOO cases with concurrent TBS evaluation. Co-primary outcomes were TBS retention at 1 and 5min. Secondary outcomes were symptoms and manometric metrics of EGJ function and peristaltic integrity. One hundred patients were included (25 each of types I-III and conclusive EGJOO). TBS retention measured by height and width at 1 and 5min differed significantly across the four subtypes (p<0.0001 all comparisons), with esophageal stasis tending to be significantly greater for types I and II achalasia (88% and 84% with >5cm column at 5min) compared to type III and EGJOO (24% and 8% with >5cm column; p<0.0001). Eckardt symptom severity was similar across subtypes (p=0.30). Magnitude of esophageal stasis and integrated relaxation pressure (IRP) were uncorrelated (R=0.21). In EGJOO, the number of swallows with intact peristalsis inversely correlated with barium column height (R=-0.49) and those with disordered peristalsis were more likely to have any residual barium at 5min compared to those without disordered peristalsis (43% vs. 0%; p=0.02). Timed barium swallow findings differed markedly with significantly less esophageal stasis in type III achalasia and EGJOO, despite similar symptom severity and no correlation between degree of emptying and IRP. Preservation of peristalsis may underlie this finding in EGJOO.

One year comprehensive prospective follow-up of achalasia patients after peroral endoscopic myotomy

Background and aims Peroral endoscopic myotomy (POEM) is an established therapy for achalasia, but outcome evaluation has often been limited to Eckardt score (ES). The present study was aimed to improve knowledge about outcome evaluation and predictive outcome factors by performing a comprehensive objective evaluation of achalasia patients treated by POEM. Methods This single centre prospective study reports outcome data 12 months after POEM in treatment-naive achalasia patients. A predefined follow-up protocol included ES, high resolution manometry, 24-h pH measurement, upper endoscopy and timed barium esophagogram (TBE). Univariate and multivariate regression analyses were performed to analyze association between post-POEM variables and identify predictive factors for objective outcome. Results Fifty patients were included with a drop-out rate of <5%. ES, lower oesophageal sphincter pressures, TBE heights and maximal oesophageal diameter were all reduced after POEM (p < .001), and 28% (13/47) of the patients had a positive 24-h pH registration. An oesophageal diameter >3 cm after POEM was associated with treatment failure assessed by ES (p = .04) and TBE (p = .03). Advanced achalasia stage (p = .02) and long symptom duration (p = .04) were identified as independent predictive factors for poor outcome assessed by TBE. Conclusions The present study confirms that POEM is an efficient therapy for achalasia. The comprehensive objective evaluation after POEM demonstrates that long symptom duration and major changes in oesophageal anatomy at diagnosis imply poor treatment outcome, and a post-POEM dilated oesophagus is associated with treatment failure. Key messages Peroral endoscopic myotomy (POEM) is established as a safe and effective therapy for achalasia. Timed barium esophagogram offers objective variables that are valuable in treatment response evaluation. Advanced achalasia stage and long symptom duration are predictive factors for poor objective treatment response after POEM.

Timed barium swallow for assessing long-term treatment response in patients with achalasia: Absolute cutoff versus percent change - A cross-sectional analytic study.

Timed barium swallow (TBS) assesses esophageal emptying before and after therapy in patients with achalasia. Our aim was to compare the accuracy of percent change in barium height with traditional absolute cutoff of <5cm on post-treatment TBS. Consecutive patients with treatment naïve achalasia treated with either PD, HM, or POEM between 1/2012 and 7/2017 were eligible for inclusion. The accuracy of percent change in pre- and post-treatment barium height at 5minutes versus an absolute <5cm cutoff for assessing treatment response was assessed using the receiver operating curve analysis (ROC). Eighty-one patients met the inclusion criteria. The median percent change in barium heights at five minutes in patients who did not improve was 6 percent increase (n=10; mean 10.6) versus 78 percent decrease (n=71; mean 64) in patients who improved (P=0.0001). The AUC for percent change in TBS 5 minutes height was 76% (95% CI 48% to 90%), and a 3% decrease from baseline as a cutoff had a sensitivity of 60% and specificity of 99%. The AUC for post-treatment TBS 5 minutes height was 79% (95% CI 53% to 91%), and the 5cm cutoff had a sensitivity of 70% and specificity of 75%. The results show that 3% percent improvement in pre- and post-treatment barium height at 5 minutes rather than absolute cutoff value of <5cm on post-treatment TBS is a better indicator of treatment success in achalasia patients. These findings indicate the need for reassessment of tools to identify treatment response.

386 LAPAROSCOPIC HELLERS MYOTOMY AND ANGLE OF HIS ACCENTUATION FOR ACHALASIA CARDIA: 10 YEARS EXPERIENCE FROM A SINGLE SURGICAL CENTRE.

Abstract Achalasia is a rare disease with Laparoscopic Hellers cardio-myotomy (LHCM) being the gold standard surgical modality. An antireflux procedure is required along with myotomy to decrease the chances of reflux postoperatively. We have performed Angle of His Accentuation (AOH) as an anti-reflux procedure in 126 patients who underwent LHCM since 2010. This study presents the symptomatic and objective outcomes of LHCM with AOH. Methods Review of prospectively collected data of patients with Achalasia cardia undergoing LHCM with AOH from 2010–2019. Subjective symptoms were scored for dysphagia, heartburn, regurgitation and quality of life using scoring systems mentioned in table 1 and Achalasia specific health related Quality of life questionnaire (ASHRQoL). Objective tests included Timed Barium swallow, Endoscopy and high-resolution manometry. Patients were evaluated in pre and postoperative period at regular intervals. Success was defined as follows: Eckardt score of ≤3, Dysphagia score of 0/1, Regurgitation and heartburn score of 0, &amp;gt;50% clearance on timed barium swallow, IRP &amp;lt;15 and absence of esophagitis. Results 126 patients were operated during the study period with no mortality or conversion. Mean age was 33.5(years), symptom duration 49.8(months), 31 had preoperative dilatation. The mean operative time was 131 (minutes). Subjective outcome was available in all patients &amp; objective data in 66. At median follow of 31 months (IQR 15–59) outcomes significantly improved (Table 1) with 93% having dysphagia relief. 14 (11%) had new onset heartburn; 6(4.7%) needed regular proton pump inhibitors. ASHRQoL improved significantly (59.51 to 19.57). Pre&amp;post-operative IRP, Timed Barium and endoscopy available in 66,39 and 62 patients improved significantly. 6(9.6%) patients had endoscopic evidence of esophagitis (LA-A 3, B/C 3). Conclusion Laparoscopic Heller myotomy with Angle of His accentuation is safe simple and effective procedure for Achalasia cardia. It provides significant relief of symptoms, improvement in quality of life and improvement in objective parameters. Post- operative heartburn and esophagitis is acceptable. We recommend Angle of His accentuation as an adjunct to Laparoscopic Heller myotomy.

Implementation of a Timed Barium Esophagram Protocol for Assessment of Esophageal Function in Children.

Timed barium esophagram (TBE) is a fluoroscopic study that is widely employed as an adjunctive tool for diagnosing esophageal emptying disorders in adults (eg, achalasia, esophagogastric junction outflow obstruction [EGJOO]) and for following response to treatment. We aimed to describe the characteristics and feasibility of a pediatric TBE protocol and provide a first report of the potential value of TBE for assessment of esophageal emptying in the pediatric population. Retrospective chart review of pediatric patients at a tertiary pediatric hospital who underwent TBE from October 2017 to October 2019. Patient and test characteristics were summarized using descriptive statistics. Results from patients who had both TBE and high-resolution esophageal manometry (HRM) were used to generate ROC curves for TBE to identify esophageal emptying disorders. Twenty-two patients underwent 25 TBE. Fourteen of 23 (61%) received 150 mL barium volume per protocol. Nearly half (42%) of subjects could tolerate ingesting barium within 20 seconds. Nine individuals underwent HRM. The sensitivity of standard adult TBE criteria (1 cm barium column height at 5 minutes) to detect emptying disorder was 100%, specificity 40%. A modified diagnostic cutoff (1.6 cm height at 5 minutes) offered 100% sensitivity, 80% specificity. TBE is feasible and should be considered an adjunctive noninvasive screen for impaired esophageal emptying in children. There was heterogeneous adherence to protocol for timing and volume of barium; however, studies remained interpretable. This population may benefit from different diagnostic cutoffs than adults, and clinical judgment should be used until specific diagnostic cutoffs are determined in children.

Elevated Intrabolus Pressure Predicts Abnormal Timed Barium Esophagram in Esophagogastric Junction Outflow Obstruction.

Background/AimsTimed barium esophagram (TBE) is used the classification of esophageal motility disorders and assessing esophageal function. Currently, there are no published studies examining the relationship between high-resolution manometry and TBE in patients with esophagogastric junction outflow obstruction (EGJOO). This study seeks to evaluate this relationship and identify manometric variables that may indicate further evaluation using TBE.MethodsRetrospective review of medical records identified patients with a diagnosis of EGJOO per the Chicago classification version 3.0. TBE was performed using standard protocol. Patients were divided into 2 groups based on complete emptying or persistence of standing barium column at 5 minutes.ResultsEleven patients were identified with EGJOO who underwent both high-resolution manometry and TBE within 3 months. Five patients had no standing barium column at 5 minutes, while 6 patients had a persistent barium column. Mean age of each group was 54.0 years and 57.8 years, respectively. Patients with abnormal TBE were found to have significantly elevated intrabolus pressure (IBP) compared with patients who had a normal TBE.ConclusionsIn our study, we found significant differences in IBP between these patient groups. These findings suggest that patients with EGJOO and elevated IBP may prompt further clinical evaluation with TBE in order to clarify clinical diagnosis and guide therapeutic intervention.

1803 Pseudoachalasia Following Nissen Fundoplication: A Progression Documented With High Resolution Manometry

INTRODUCTION: Pseudoachalasia, indistinct from achalasia in symptoms and high-resolution manometry (HRM) findings, varies by a secondary etiology. Over half of the occurrences arise from malignancy and seldom following surgeries involving the esophagus. This case presents a rare development of pseudoachalasia following Nissen fundoplication, further unique by documenting complete progression on HRM. CASE DESCRIPTION/METHODS: A 68-year-old male with continued dysphagia and gastroesophageal reflux disease underwent repeat EGD showing progression to LA grade B (from grade A) esophagitis and a 5cm (from 3cm) hiatal hernia. Initial HRM had normal findings (Figure 1A). Laparoscopic Nissen fundoplication was performed. Recurrence of symptoms led to two stricture dilations in one year. Repeat HRM showed intact peristalsis and normal LES relaxation, but six of ten swallows had decreased distal latency &lt; 4.5 seconds consistent with esophageal spasm (Figure 1B). He was referred to an esophageal disease clinic and reported dysphagia, poor pill swallow and 15lb unintentional weight loss. Timed barium esophagram revealed a high-grade obstruction in the distal esophagus (Figure 2). EGD had significant resistance to gastric intubation of the scope concerning for an extrinsic compression or achalasia. A CT chest, abdomen and pelvis showed no extrinsic masses or alternative malignancy. HRM had 100% incomplete liquid bolus transit, elevated LES basal (56.7mmHg) and median integrated relaxation (22.4 mmHg) pressures with complete aperistalsis validating Type I Achalasia by Chicago Classifications (Figure 1C). Diagnosis was mechanical esophagogastric junction outflow obstruction with pseudoachalasia secondary to a tight Nissen fundoplication. After Nissen fundoplication takedown, dysphagia resolved and results were maintained at follow up. DISCUSSION: The etiology of pseudoachalasia in this case was theorized as myenteric plexus injury during wrap construction or degeneration from sustained distal obstruction. Intermediary esophageal spasms on HRM may forewarn of developing pseudoachalasia. One should understand the risk, albeit rare, of post-Nissen fundoplication dysmotility. Being cognizant of a possible HRM progression, as identified in this patient, may spur earlier clinical follow up, repeat testing or intervention. Finally, those with rapid onset of achalasia symptoms over age 50 should raise concern and be evaluated with barium esophagram, EGD with biopsies, CT scan and HRM to decipher a secondary etiology.

Su1602 – Novel Use of Timed Barium Esophagram Protocol for Assessment of Esophageal Function in Children

Su1602 – Novel Use of Timed Barium Esophagram Protocol for Assessment of Esophageal Function in Children

Functional assessment of achalasia

The treatment of achalasia is dependent on evaluation of esophageal function of patients with this progressive disorder. This begins with an evaluation of its symptoms and their severity. The Eckardt scale is the most widely used, though it has limitations. Timed barium swallow evaluation provides a simple inexpensive means to evaluate esophageal emptying across a non-relaxing lower esophageal sphincter, before and after therapy. High resolution esophageal manometry has improved our ability to assess both esophageal body and sphincteric function. It has allowed identification of manometric phenotypes, which help prognosticate response to therapy. Esophageal impedance measurements of liquid swallows and esophageal emptying are a new and promising advance. Endoscopic ultrasound can measure esophageal muscle thickness, but has an adjunctive role mainly aimed at excluding structural abnormalities, such as malignancy causing secondary achalasia.

Elevated Average Maximum Intrabolus Pressure on High Resolution Manometry Is Associated with Esophageal Dysmotility and Delayed Esophageal Emptying on Timed Barium Esophagrams: Presidential Poster Award

Elevated Average Maximum Intrabolus Pressure on High Resolution Manometry Is Associated with Esophageal Dysmotility and Delayed Esophageal Emptying on Timed Barium Esophagrams: Presidential Poster Award

Sa2015 - The Timed Barium Esophagogram, a Useful Adjunct in Evaluating Pediatric Esophageal Motor Disorders

Sa2015 - The Timed Barium Esophagogram, a Useful Adjunct in Evaluating Pediatric Esophageal Motor Disorders

Mo1508 - Pneumatic Dilation Improves Esophageal Emptying on Timed Barium Esophagram in Patients with Esophago-Gastric Junction Outflow Obstruction

Mo1508 - Pneumatic Dilation Improves Esophageal Emptying on Timed Barium Esophagram in Patients with Esophago-Gastric Junction Outflow Obstruction