Pneumatic dilation improves esophageal emptying and symptoms in patients with idiopathic esophago‐gastric junction outflow obstruction

• Published in: Neurogastroenterology and motility 2019-03, Vol.31 (3), p.e13522-n/a
• Main Authors: Clayton, Steven B., Shin, Claire M., Ewing, Alex, Blonski, Wojciech, Richter, Joel
• Format: Article
• Language: English
• Subjects: Aged; Barium; Barium Sulfate; Dilatation - methods; EGJOO; Esophageal Achalasia - diagnostic imaging; Esophageal Achalasia - physiopathology; Esophageal Achalasia - therapy; Esophageal sphincter; Esophageal Sphincter, Lower; Esophagogastric Junction - diagnostic imaging; Esophagogastric Junction - physiopathology; Esophagoscopy; Esophago‐gastric junction outflow obstruction; Esophagus; Esophagus - diagnostic imaging; Esophagus - physiopathology; Female; Gastroscopy; Humans; Male; Patient Satisfaction; Patients; pneumatic dilation; Sphincter; Stomach Diseases - diagnostic imaging; Stomach Diseases - physiopathology; Stomach Diseases - therapy; Surveys and Questionnaires; timed barium esophagram; Treatment Outcome
• ISSN: 1350-1925; 1365-2982
• DOI: 10.1111/nmo.13522

Background and aims Idiopathic Esophago‐gastric outflow obstruction (EGJOO) is a new clinical entity resulting in delayed esophageal emptying secondary to a poorly relaxing lower esophageal sphincter. Little is known about treatment outcomes of idiopathic EGJOO patients. The aim of this study was to investigate the clinical response of pneumatic dilation (PD) in idiopathic EGJOO patients with a standing barium column and/or with pill arrest on timed barium esophagram (TBE) before and after undergoing PD. Methods Idiopathic EGJOO patients with retained liquid barium on TBE at 1 minute and/or with pill arrest in esophagus at 5 minutes were included. Patients were treated with PD and evaluated with post‐procedural TBE. Results A total of 33 patients with Idiopathic EGJOO and poor esophageal emptying on TBE were treated with PD. 67% of Idiopathic EGJOO patients reported subjective symptom relief, 18% improved and symptoms later recurred, 6% were lost to follow up, and 9% reported no change. TBE results of pre‐PD showed 1 minute average barium column height of 11.0 cm and 1 minute barium column width of 1.7 cm. There was significant decrease in 1 minute liquid barium column height and width (P < 0.001 and 15 mmHg) in combination with intact peristalsis. In 33 patients with EGJOO and abnormal esophageal emptying on TBE, PD relieved dysphagia symptoms and improved esophageal emptying in EGJOO patients on TBE without complication.