Clinical utility of routine barium esophagram after laparoscopic anterior esophageal myotomy for achalasia.
BACKGROUND
This study aimed to evaluate the clinical utility of routine barium esophagram after laparoscopic anterior esophageal myotomy for achalasia.


METHODS
The records of 260 consecutive patients who underwent laparoscopic anterior esophageal myotomy for achalasia from May 1996 to August 2007 were reviewed from a prospective institutional review board-approved database. Data are given as mean +/- standard deviation. Statistical significance (p \ 0.05) was determined using a two-tailed t-test and Fisher's exact test.


RESULTS
Routine protocol barium esophagrams performed for 236 patients a mean of 1 +/- 0.3 days postoperatively were interpreted for 145 (61.4%) of the patients as normal flow of contrast after esophageal myotomy. There were no false-negative studies in this group, and diet was initiated without incident at a mean of 1 +/- 0.2 days. The time to the goal diet was 1.3 +/- 0.7 postoperative days, and the mean postoperative time to discharge was 1.5 +/- 1 days. Of the 236 patients, 91 (38.6%) had an abnormal barium esophagram (contrast retention or pooling, delayed emptying). For this group, initiation of a diet was delayed for only six (6.6%) patients. Two barium esophagrams (0.9%) interpreted as an esophageal leak were determined to be false-positives after the one patient underwent negative exploratory laparoscopy and the other was observed clinically. In this group, diet was initiated at a mean of 1.1 +/- 0.3 days. The time to the goal diet was 1.4 +/- 0.7 days, and the mean postoperative time to discharge was 1.8 +/- 1.9 days. The mean times to diet initiation, goal diet, and discharge were not significantly different (p >or= 0.14) between the normal and the abnormal barium esophagram groups. The sensitivity and specificity of an abnormal routine barium esophagram after laparoscopic esophageal myotomy were, respectively, 100% and 62.0%, and the positive and negative predictive values were 2.2% and 100%.


CONCLUSIONS
Because of its poor positive predictive value, routine barium esophagram after laparoscopic anterior esophageal myotomy should be used selectively in the immediate postoperative period after an uncomplicated procedure.
Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St Louis, MO 63110, USA. melmanl@wudosis.wustl.edu
Lora
L
Melman
Jessica A
JA
Quinlan
Bruce L
BL
Hall
L Michael
LM
Brunt
Richard A
RA
Pierce
Valerie
V
Halpin
J Christopher
JC
Eagon
Brian
B
Robertson
Margaret
M
Frisella
Brent D
BD
Matthews
D001466:Barium Sulfate; D003287:Contrast Media; D004931:Esophageal Achalasia / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity
D003287:Contrast Media; D001466:Barium Sulfate