The Changes of High Resolution Esophageal Manometry After Peroral Endoscopic Myotomy

Background Achalasia is a primary motility disorder, which presented by dysphagia. The most effective treatment of the disease is surgical (peroral myotomy or laparoscopic myotomy). However, there are few studies which assess the changes in esophageal motility after surgery. The aim of our study was evaluating the changes in esophageal manometry in patients with achalasia after peroral endoscopic myotomy (POEM). Methods 43 patients with achalasia were consequently observed before and 1 year after POEM. Females predominated (28 subjects). All patients examined endoscopically, then high resolution manometry (HRM) was performed by Solar™ GI (MMS/Laborie, Netherland). Achalasia was defined as described in Chicago Classification 4.0. Eight patients had I type of achalasia, 24—II type and 11—III type. All patients were devided into two groups. Group A: in 35 patients the median Eckardt score decreased from 7 to 2. Group B: 8 patients were dissatisfied with the surgery. Results According to HRM the mean resting pressure (RP) of LES (lower esophageal sphincter) in group A reduced from 39.1 ± 2.7 mmHg to 18.9 ± 1.4 mmHg. Also we revealed the decrease in integrated residual pressure (IRP) from 22.8 ± 0.7 to 9.8 ± 0.6 mmHg and DCI (distal contractile interval): from 1865.5 ± 286.9 to 128.2 ± 53.8 mmHg*s*cm. In a group B the mean RP of LES reduced from 48.8 ± 2.4 to 33.6 ± 2.4 mmHg. The IRP decreased from 22.8 ± 0.7 mmHg to 15.01 ± 0.6 mmHg and DCI: from 2999.6 ± 417.6 mmHg*s*cm to 1038.1 ± 107.7 mmHg*s*cm. Conclusion The reduction of resting pressure, integrated resting pressure and distal contractile interval can be accepted as criteria of POEM effectiveness. Besides, in patients with III type of achalasia we must assess the absence of spastic contraction as additional criteria of POEM satisfaction.