A comparison of esophagography and esophageal transit scintigraphy in the evaluation of usefulness of endoscopic pneumatic dilatation in achalasia.
BACKGROUND
Esophageal transit scintigraphy and barium esophagography have been used for evaluation of therapeutic results in patients with achalasia. It remains to be determined which method is most useful, and whether both studies are necessary before and after treatment for achalasia.


OBJECTIVE
To evaluate the usefulness of both esophagography and esophageal transit scintigraphy (ETS) to determine the efficacy of endoscopic pneumatic dilatation (EPD) in patients with achalasia.


METHODS
Seventeen patients (6 M, 11 F) with achalasia underwent both esophagography and ETS before and after EPD. Esophagographic findings were reviewed to determine the length and caliber of stenosis in the esophagogastric channel. Dynamic images of ETS were evaluated on time-activity curves. Changes in the clinical symptom score were evaluated. Statistical analyses of esophagography and ETS before and after EPD were performed.


RESULTS
After EPD, the mean symptom score improved (P<0.05). The mean residue of radioisotope in ETS also improved after EPD, with a statistically significant correlation (P<0.05). There was a statistically significant correlation between the improved symptom scores and the change in ETS after EPD (P<0.05). There was no statistical correlation between clinical symptom scores and esophageal caliber, regardless of EPD (P>0.05). With an 8-mm diameter of the esophagogastric channel as a benchmark for successful treatment, there was no statistical correlation between esophagography and ETS at 15 s after EPD (P>0.05).


CONCLUSIONS
Esophagography was useful for the evaluation of morphology and caliber of the esophagogastric channel, while ETS was useful for the functional evaluation of esophageal emptying. Both studies may therefore be considered necessary to evaluate the efficacy of EPD in patients with achalasia.
Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea. jjchung@yuhs.ac
J-J
JJ
Chung
H J
HJ
Park
J S
JS
Yu
Y J
YJ
Hong
J H
JH
Kim
M-J
MJ
Kim
S I
SI
Lee
D000293:Adolescent; D000328:Adult; D000368:Aged; D001464:Barium; D002404:Catheterization / Q000379:methods*; D004931:Esophageal Achalasia / Q000628:therapy*; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011312:Pressure; D011859:Radiography; D011877:Radionuclide Imaging; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
D001464:Barium