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The preoperative manometric pattern predicts the outcome of surgical treatment for esophageal achalasia.

AbstractBACKGROUND:
A new manometric classification of esophageal achalasia has recently been proposed that also suggests a correlation with the final outcome of treatment. The aim of this study was to investigate this hypothesis in a large group of achalasia patients undergoing laparoscopic Heller-Dor myotomy.
METHODS:
We evaluated 246 consecutive achalasia patients who underwent surgery as their first treatment from 2001 to 2009. Patients with sigmoid-shaped esophagus were excluded. Symptoms were scored and barium swallow X-ray, endoscopy, and esophageal manometry were performed before and again at 6 months after surgery. Patients were divided into three groups: (I) no distal esophageal pressurization (contraction wave amplitude <30 mmHg); (II) rapidly propagating compartmentalized pressurization (panesophageal pressurization >30 mmHg); and (III) rapidly propagating pressurization attributable to spastic contractions. Treatment failure was defined as a postoperative symptom score greater than the 10th percentile of the preoperative score (i.e., >7).
RESULTS:
Type III achalasia coincided with a longer overall lower esophageal sphincter (LES) length, a lower symptom score, and a smaller esophageal diameter. Treatment failure rates differed significantly in the three groups: I = 14.6% (14/96), II = 4.7% (6/127), and III = 30.4% (7/23; p = 0.0007). At univariate analysis, the manometric pattern, a low LES resting pressure, and a high chest pain score were the only factors predicting treatment failure. At multivariate analysis, the manometric pattern and a LES resting pressure <30 mmHg predicted a negative outcome.
CONCLUSION:
This is the first study by a surgical group to assess the outcome of surgery in 3 manometric achalasia subtypes: patients with panesophageal pressurization have the best outcome after laparoscopic Heller-Dor myotomy.
AuthorsRenato Salvador, Mario Costantini, Giovanni Zaninotto, Tiziana Morbin, Christian Rizzetto, Lisa Zanatta, Martina Ceolin, Elena Finotti, Loredana Nicoletti, Gianfranco Da Dalt, Francesco Cavallin, Ermanno Ancona
JournalJournal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract (J Gastrointest Surg) Vol. 14 Issue 11 Pg. 1635-45 (Nov 2010) ISSN: 1873-4626 [Electronic] United States
PMID20830530 (Publication Type: Journal Article)
Topics
  • Adult
  • Esophageal Achalasia (pathology, physiopathology, surgery)
  • Esophageal Sphincter, Lower (pathology, physiopathology)
  • Esophagus (pathology, physiopathology)
  • Female
  • Humans
  • Laparoscopy
  • Male
  • Manometry
  • Middle Aged
  • Treatment Outcome

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