Assessment of esophageal emptying post-pneumatic dilation: Use of the timed barium esophagram

OBJECTIVES: The reported success rate of pneumatic dilation in patients wit h achalasia varies from 50% to 93%. This wide variability may be due to usi ng symptom relief post-dilation as the only assessment of success. There ar e no studies comparing subjective symptom improvements to objective improve ment in esophageal emptying after pneumatic dilation. METHODS: Patients with achalasia undergoing pneumatic dilation from 1995 to 1997 were evaluated. Pre- and post-dilation symptoms were recorded using a standardized scoring system. Barium column height was measured 1 min and 5 min after upright ingestion to assess esophageal emptying. Based on percen tage of total symptom and barium height improvement post-dilation, patients were grouped according to one of nine outcomes; the association between su bjective and objective parameters of improvement was tested. RESULTS: A total of 37 patients underwent 53 pneumatic dilations. There was a significant association (p < 0.001) between improvement in patient sympt oms and barium height. in 38 of 53 (72%) pneumatic dilations, the degree of symptom and barium height improvement was similar. Near complete symptom r esolution was reported after 26 dilations. In eight of 26 (31%) patients ho wever, there was <50% improvement in barium height (group A). Compared with the 16 patients with 91-100% improvement in both symptoms and barium heigh t (group B), forward stepwise regression identified age as the only differe nce between the two groups, with group A patients being significantly (p = 0.04) older. CONCLUSIONS: Objective assessment of esophageal emptying pre- and post-dila tion identifies an important subset of patients with poor esophageal emptyi ng who report: near complete symptom resolution. This group may benefit fro m any early repeat pneumatic dilation. (Am J Gastroenterol 1999;94:1802-180 7. (C) 1999 by Am. Coll. of Gastroenterology).