PubMed · 13759875
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B T LE ROUX, J T WRIGHT. 1961. Cardiospasm.. https://doi.org/10.1002/bjs.18004821208
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Radiologic studies can be helpful when evaluating patients who are suspected of having esophageal motility disorders. Performing studies of the highest technical quality yields the most definitive results. The esophagus should be assessed for anatomic and functional abnormalities that may account for presenting symptoms. Motility disorders such as achalasia and scleroderma have specific radiographic findings that are described in this article; however, some motility disorders of the esophagus have nonspecific radiographic findings. In those cases, it is imperative that clinical and manometric information be combined with radiographic findings to provide accurate diagnoses. The radiographic examinations that are most commonly used include barium esophagography and nuclear medicine examinations. This article emphasizes the use of barium examinations to assess esophageal motility.
BACKGROUND: We describe the findings on esophagography, the frequency and appearance of leaks after laparoscopic Heller myotomy and fundoplication, and the utility of early postoperative studies for predicting clinical outcome. METHODS: Our study group consisted of 40 patients who underwent laparoscopic Heller myotomy and fundoplication in whom radiographic studies were performed during the early postoperative period. The radiographic reports and images were reviewed to determine the esophageal diameter, visualization or nonvisualization of the wrap, and the presence or absence of a leak. The esophageal diameter subsequently was correlated with the clinical findings to determine whether this was a useful parameter for predicting clinical outcome. RESULTS: Two patients (5%) had small, sealed-off leaks on radiographic studies, and four (10%) had pseudo-leaks resulting from trapping of contrast material alongside the fundoplication wrap. Twelve (60%) of 20 patients with a dilated esophagus had esophageal symptoms on short-term follow-up versus three (15%) of 20 with a normal-caliber esophagus (p = 0.008), and five (56%) of nine patients with a dilated esophagus had symptoms on long-term follow-up versus six (43%) of 14 with a normal-caliber esophagus (p = 0.68). CONCLUSION: Radiographic studies are useful for showing leaks after laparoscopic Heller myotomy and fundoplication, but radiologists should differentiate true leaks from trapping of contrast material alongside the fundoplication wrap. The caliber of the esophagus on early postoperative studies is also a useful parameter for predicting short-term clinical outcome in these patients.