Association of High-Resolution Manometry Metrics with the Symptoms of Achalasia and the Symptomatic Outcomes of Peroral Esophageal Myotomy

Abstract

Background: High-resolution manometry (HRM) has improved the accuracy of manometry in detecting achalasia and has helped distinguish between clinically relevant subtypes. This study investigated whether HRM metrics correlate with the achalasia symptoms and symptomatic outcomes of peroral esophageal myotomy (POEM).

Methods: Of the 30 patients who were enrolled, 25 were treated with POEM, 12 of who underwent HRM after 3 months. All the patients completed the Eckardt score questionnaires, and those who underwent POEM were followed up for about 6 months. Pearson correlation was used to assess the relationship between the HRM metrics and symptoms and outcomes.

Key results: The integrated relaxation pressure (IRP) score positively correlated with the total Eckardt score, regurgitation score and weight loss score in all the patients, and with the weight loss score in type I achalasia. In 25 patients (10 patients, type I; 15 patients, type II) who underwent POEM, the total Eckardt scores and individual symptom scores significantly decreased after surgery. Changes in the Eckardt scores were similar between type I and type II. Further, the Eckardt scores and weight loss score changes were positively correlated with baseline IRP. Twelve patients (4 patients, type I; 8 patients, type II) underwent HRM again after POEM. IRP changed significantly after POEM, as did the DEP in type II. The IRP changes after POEM were positively correlated with the Eckardt score changes.

Conclusions & inferences: IRP is correlated with the symptoms and outcomes of achalasia patients. Thus, HRM is effective for assessing the severity of achalasia and can predict the efficacy of POEM.

Fig 1. Correlation between HRM metrics and Eckardt scores at the baseline.

(A) Correlation between IRP and the total Eckardt score in all 30 patients, (B) correlation between IRP and the Eckardt score for regurgitation in all 30 patients, (C) correlation between IRP and the Eckardt score for weight loss in all 30 patients, (D) correlation between IRP and the Eckardt score for weight loss in type I achalasia patients.

Fig 2. Changes in the Eckardt score of patients with achalasia after POEM and its correlation with IRP.

Changes in the Eckardt score of patients with type I (A, n = 10) and type II (B, n = 14) achalasia after POEM: correlation between IRP before POEM and changes in the total Eckardt score (C), correlation between IRP before POEM and changes in the Eckardt score for weight loss after POEM (D, n = 24), and (E) correlation between IRP changes and changes in the Eckardt score for weight loss after POEM (n = 12).