Esophageal emptying assessed at the 'timed
barium' esophagogram correlates well with symptomatic outcomes after pneumatic dilation for
esophageal achalasia, although 30% of patients with satisfactory outcome exhibit partial improvement in emptying. The aim of the study was to investigate any correlation of esophageal emptying to symptomatic response after laparoscopic
Heller's myotomy and Dor's
fundoplication. 'Bread and
barium' (transit time of a
barium opaque bread bolus) and 'timed
barium' (height of esophageal
barium column 5 minutes after ingestion of 200-250 mL of
barium suspension) esophagogram was used to assess esophageal emptying in 73 patients with
esophageal achalasia before 1 and 5 years (31 cases) after laparoscopic
myotomy and anterior
fundoplication. Symptoms assessment was based to a specific score. At 1-year follow-up, excellent and good symptomatic results were obtained in 95% of the cases. Esophageal maximum diameter, esophageal transit time, and esophageal
barium column were significantly correlated to each other and to symptom score postoperatively (P < 0.001). Complete and partial (<90% and 50-90% postoperative reduction in
barium column, respectively) emptying was seen in 55% and 31% of patients with excellent result. Patients with a pseudodiverticulum postoperatively had a more delayed esophageal emptying than those without. Symptomatic outcome and esophageal emptying did not deteriorate at 5-year follow-up. Esophageal emptying assessed by '
barium and bread' and 'timed
barium' esophagogram correlated well with symptomatic outcome after laparoscopic
myotomy for
esophageal achalasia. Complete symptomatic relief does not necessarily reflect complete esophageal emptying. Outcomes do not deteriorate by time. Because of wide availability, esophagogram can be applied in follow-up of postmyotomy patients in conjunction with symptomatic evaluation.