Details

Autor(en) / Beteiligte

• Farina, Domenico A.
• Olson, Dylan A.
• Carlson, Dustin A.
• Kahrilas, Peter J.
• Vespa, Edoardo
• Koop, Andree H.
• Arroyo, Yadis
• Goudie, Eric
• Pandolfino, John E.

Titel

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

Ist Teil von

• Neurogastroenterology and motility, 2024-06, Vol.36 (6), p.e14785-n/a

Ort / Verlag

England: Wiley Subscription Services, Inc

Erscheinungsjahr

2024

Quelle

Wiley-Blackwell Journals

Beschreibungen/Notizen

• 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. 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. 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). 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. The physiomechanical goal of achalasia treatment is to reduce dilatation of the esophagus (decompress) and improve bolus retention. Successful reduction in esophageal dilatation with achalasia therapy is associated with improved esophageal emptying and symptomatic improvement compared to patients with a partial response or failure to reduce esophageal width and/or esophageal emptying with treatment.