J Neurogastroenterol Motil  https://doi.org/10.5056/jnm19135
Role of Rapid Drink Challenge During Esophageal High-resolution Manometry in Predicting Outcome of Peroral Endoscopic Myotomy in Patients With Achalasia
Hélène Foisy,1,2 Mathieu Pioche,1,3 Edouard Chabrun,4 Thierry Ponchon,1,3 Frank Zerbib,4 Jérôme Rivory,1 François Mion,2,3,5 and Sabine Roman 2,3,5*
1Université de Lyon, Hospices Civils de Lyon, Gastroenterology, Hopital E Herriot, Lyon, France ; 2Université de Lyon, Lyon I University, Digestive Physiology, Lyon, France; 3Université de Lyon, Inserm U1032, Labtau, Lyon, France; 4Université de Bordeaux, CHU de Bordeaux, Gastroenterology, Hôpital Haut Leveque, Pessac, France; and 5Université de Lyon, Hospices Civils de Lyon, Digestive Physiology, Hôpital E Herriot, Lyon, France
Correspondence to: Sabine Roman, MD, PhD
Digestive Physiology, Hôpital Edouard Herriot 5, place d’Arsonval 69437 Lyon cedex 03, France
Tel: +33-4-7211-0136, Fax: +33-4-7211-0147, E-mail: sabine.roman@chu-lyon.fr
Received: July 11, 2019; Accepted: November 1, 2019; Published online: February 6, 2020.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

Abstract
Background/Aims
Peroral endoscopy myotomy (POEM) is effective to treat achalasia. We aim to determine POEM effect on esophageal function and search for predictive factors of response to POEM and co-occurrence of gastroesophageal reflux disease (GERD).
Methods
A total of 64 untreated achalasia patients who underwent high-resolution manometry (HRM) before and 3 months after POEM were retrospectively included. Response to treatment was defined as an Eckardt score < 3. Reflux symptoms and patient’s satisfaction were evaluated. Data were compared using paired t test, Chi-square test or log rank test.
Results
The 2-year success rate in response to POEM was 90%. All responders reported being satisfied while only 33% of non-responders did (P < 0.0001) and 64% of patients with reflux symptoms were satisfied versus 96% of those without (P = 0.009). On HRM, the integrated relaxation pressure and the contractile pattern changed significantly after POEM but were not predictive of response. Between pre and post POEM HRM, a decrease in maximal esophageal pressurization during rapid drink challenge (RDC) was associated with a better response rate than an increase of pressurization (91% vs 50%, P = 0.004). As evidenced by pH monitoring performed after POEM, GERD was pathological or borderline in 50% of patients (18/36) while only 19% (11/59) reported clinically significant reflux symptoms. On post POEM HRM, maximal esophageal pressurization during RDC was lower in patients with pathological or borderline GERD compared to those without (P = 0.054).
Conclusions
Esophageal HRM parameters changed significantly after POEM. Maximal esophageal pressurization during RDC may be useful to predict outcome.
Keywords: Esophageal achalasia; Gastroesophageal reflux; Manometry; Myotomy


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