HIGH-RESOLUTION IMPEDANCE MANOMETRY METRICS OF THE EG-JUNCTION FOR PREDICTING CLINICAL RESPONSE FOLLOWING PERORAL ENDOSCOPIC MYOTOMY IN ACHALASIA

Aims Peroral endoscopic myotomy (POEM) is an effective treatment for achalasia. There is still controversy, which method is the best to predict clinical response following POEM. We aimed to evaluate changes at esophagogastric junction pressure (EGJP) and integrated relaxation pressure (IRP4) in high resolution manometry (HRM) in patients with achalasia before and after POEM as indicators for treatment response.

Methods We retrospectively evaluated 135 patients (mean age: 54.3 (±18.2) years) with achalasia during 3-months follow up after POEM with Eckardt score (ES) and HRM. Clinical response was defined as ES≤3. Receiver-operating characteristic (ROC) curves for good symptomatic outcome (ES≤3) were generated for each potential predictor of treatment response (∆EGJP, ∆IRP4, %∆EGJP,%∆IRP4).

Results 87% of patients showed a good symptomatic outcome after POEM. Mean EGJP and IRP4 values reduced significantly after POEM (33.2(±16.2)mmHg vs. 15.3(±10.9)mmHg, P<0.001 and 20.3(±10.5)mmHg vs. 8.4(±8.2)mmHg, P<0.001, respectively). The area-under-the-curves (AUCs) on the ROC curve for symptomatic outcome were 0.54 (∆EGJP), 0.54 (∆IRP4), 0.72 (%∆EGJP) and 0.52 (%∆IRP4). Optimal cut-points were determined as -2.5mmHg (∆EGJP), -15.1mmHg (∆IRP4), 0.47mmHg (%∆EGJP) and 0.19mmHg (%∆IRP4) that provided sensitivities/specificities of 43%/7% (∆EGJP), 71%/50% (∆IRP4), 71%/26% (%∆ EGJP) and 86%/67% (%∆IRP4) to predict symptomatic outcome. The most predictive HRM measurement for clinical response after POEM is%∆EGJP.

Conclusions HRM measurements can predict clinical response after POEM with a moderative predictive ability.%∆EGJP is the most predictive clinical measure in HRM.

Publication History

Article published online:
14 April 2022