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The following is a summary of “Three-to-six month post-POEM timed barium esophagram can predict esophageal contents and may stratify aspiration risk on follow-up EGD,” published in the April 2025 issue of the BMC Gastroenterology by Liberto et al.

Peroral endoscopic myotomy (POEM) has become a widely accepted and effective endoscopic treatment for achalasia, significantly improving esophageal emptying and reducing symptoms associated with impaired esophageal motility. Despite this, many patients who undergo POEM continue to receive endotracheal intubation (EI) during follow-up esophagogastroduodenoscopy (EGD) as a precaution against aspiration. However, routine use of EI may lead to increased procedural time, healthcare costs, and anesthesia-related risks—especially in patients whose esophageal function has normalized. This study investigates whether findings from timed barium esophagram (TBE), performed three to six months after POEM, can predict the presence of residual esophageal contents on subsequent EGD, thus serving as a surrogate marker of aspiration risk.

This retrospective analysis included patients with achalasia who underwent POEM between September 2021 and October 2023 and who completed both a follow-up TBE and EGD within the 3–6 month post-procedure window. In alignment with institutional protocol, all patients were instructed to abstain from solid foods (but allowed clear liquids) for two days preceding both pre- and post-POEM EGD to minimize the likelihood of residual esophageal contents. The primary objective was to identify TBE variables associated with the presence of liquid or solid contents on EGD. Logistic regression was used to evaluate predictive factors, and receiver operating characteristic (ROC) curve analysis was employed to assess diagnostic accuracy and determine optimal thresholds.

A total of 48 patients met the study’s inclusion criteria. Logistic regression analysis revealed that greater barium column height at 5 minutes post-ingestion was significantly associated with the presence of esophageal contents on follow-up EGD (odds ratio [OR] = 1.36; p = 0.004). ROC curve analysis demonstrated a strong predictive performance of barium column height, with an area under the curve (AUC) of 0.85. A threshold height of 7.0 cm at 5 minutes was identified as the optimal cutoff for predicting residual contents. In addition, the passage of a 13 mm barium tablet during TBE was inversely associated with esophageal contents (OR = 0.03; p = 0.002), suggesting that successful bolus transit is a reliable indicator of adequate esophageal clearance.

Findings from this study support the utility of a timed barium esophagram in stratifying aspiration risk during follow-up EGD after POEM. Specifically, a 5-minute barium column height of less than 7.0 cm and successful passage of a 13 mm tablet appear to predict an esophagus free of residual liquid or solid material following a 2-day solid food fast. These parameters may assist clinicians in identifying post-POEM patients who can safely undergo EGD without endotracheal intubation, thereby reducing unnecessary anesthesia exposure and procedural inefficiencies. TBE thus holds value not only in assessing post-treatment esophageal function but also as a decision-support tool for procedural planning in achalasia management.

Source: bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-025-03838-7