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Impact of peroral endoscopic myotomy on high-resolution manometry findings and their association with the procedure’s outcomes

Published:October 31, 2022DOI:https://doi.org/10.1016/j.gie.2022.10.039
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      Abstract

      Background & Aims

      Peroral endoscopic myotomy (POEM) is conducted for patients with esophageal motility disorders based on high-resolution manometry (HRM) findings. However, the impact of POEM on HRM findings and the associations between post-POEM HRM and outcomes have not been clarified.

      Methods

      In a multicenter, observational cohort study, patients with achalasia treated by POEM received follow-up HRM. Associations between patient characteristics, POEM procedures, and post-POEM HRM findings, including integrated relaxation pressure (IRP) and distal contractile integral (DCI), were investigated. Furthermore, the outcomes of the POEM procedure were compared with the post-POEM HRM findings.

      Results

      Of 2,171 patients, 151 (7.0%) showed residual high post-POEM IRP (≥26 mmHg, Starlet). In a multivariate analysis, high pre-POEM IRPs (odds ratio [OR]=24.3) and gastric myotomy >2 cm (OR=0.22) were found to be positive and negative predictive factors of high post-POEM IRPs, respectively. Peristalsis recovery (DCI ≥500 mmHg-cm-sec, at least one swallow, Starlet) was visible in 121 (19.6%) of 618 patients, and they were type II-III achalasia. High pre-POEM IRP (OR=2.65) and DCI ≥500 (OR=2.98) predicted peristalsis recovery, while esophageal dilation (OR=0.42) predicted a risk of no recovery. Extended myotomy did not reveal a significant impact on peristalsis recovery. High or low post-POEM IRP and DCI did not increase the incidence of clinical failure, reflux esophagitis, or symptomatic gastroesophageal reflux disease.

      Conclusions

      Extended gastric myotomy decreased IRP values, while peristalsis recovery depended on the characteristics of achalasia. A residual high post-POEM IRP does not necessarily mean clinical failure. Routine HRM follow-up is not recommended after POEM.

      Keywords

      Acronyms and abbreviations:

      AC (Absent contractility), BMI (Body mass index), CI (Confidence interval), DCI (Distal contractile integral), EMD (Esophageal motility disorder), ES (Eckardt score), GERD (Gastroesophageal reflux disease), HRM (High-resolution manometry), IEM (Ineffective esophageal motility), IRP (Integrated relaxation pressure), LES (Lower esophageal sphincter), LHM (Laparoscopic Heller myotomy), OR (Odds ratio), PD (Pneumatic dilation), POEM (Peroral endoscopic myotomy), RE (Reflux esophagitis)
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