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Effect of esophageal body recoil on clinical outcomes in non-spastic achalasia.

Authors :
Farina DA
Olson DA
Carlson DA
Kahrilas PJ
Vespa E
Koop AH
Arroyo Y
Goudie E
Pandolfino JE
Source :
Neurogastroenterology and motility [Neurogastroenterol Motil] 2024 Jun; Vol. 36 (6), pp. e14785. Date of Electronic Publication: 2024 Mar 24.
Publication Year :
2024

Abstract

Background: Despite the established efficacy of achalasia treatments on symptomatic outcomes, there are limited data evaluating the treatment effect on esophageal dilatation. This study aimed to assess the effect achalasia treatment on esophageal dilatation and the effect of esophageal width reduction ("recoil") on clinical outcomes.<br />Methods: Patients with type I or type II achalasia that completed high-resolution manometry (HRM), functional lumen imaging probe (FLIP), and timed barium esophagram (TBE) pre and post treatment were included. Esophageal width was measured using TBE. Focused subgroup analysis was performed on patients with normal posttreatment EGJ opening on FLIP. Good clinical outcomes were defined as barium column height of <5 cm at 5 min and Eckardt Score ≤3.<br />Key Results: Sixty-nine patients (41% type I and 59% type II) were included. Esophageal width decreased from pre to post treatment mean (SD) 4.2 (1.3) cm-2.8 (1.2) cm; p < 0.01. In the normal post treatment EGJ opening subgroup, esophageal width was less in patients with good TBE outcome compared to poor outcome mean (SD) 2.2 (0.7) cm versus 3.2 (1.4) cm (p < 0.01), but did not differ in good versus poor symptomatic outcome groups. Esophageal width recoil >25% posttreatment was associated with a greater rate of good TBE outcome (71% vs. 50%, p = 0.04) and good symptomatic outcome (88% vs. 50%; p = 0.04).<br />Conclusions and Inferences: Esophageal recoil was associated with good achalasia treatment outcome in patients without posttreatment EGJ obstruction. This suggests that mechanical properties of the esophageal wall, likely associated with tissue remodeling, play a role in clinical outcomes following achalasia treatment.<br /> (© 2024 The Authors. Neurogastroenterology & Motility published by John Wiley & Sons Ltd.)

Details

Language :
English
ISSN :
1365-2982
Volume :
36
Issue :
6
Database :
MEDLINE
Journal :
Neurogastroenterology and motility
Publication Type :
Academic Journal
Accession number :
38523321
Full Text :
https://doi.org/10.1111/nmo.14785