ABSTRACT Background Clinical non‐response to peroral endoscopic myotomy (POEM) is a major clinical challenge of achalasia. Four‐dimensional high‐resolution impedance manometry (4D‐HRIM) enables evaluation of both esophageal motility and bolus clearance. This study investigated whether 4D‐HRIM could predict outcomes of POEM in achalasia patients. Methods Achalasia patients who underwent preoperative 4D‐HRIM evaluation and POEM were retrospectively included. The baseline characteristics, myotomy metrics, traditional preoperative examinations metrics, and 4D‐HRIM metrics were compared between clinical response and non‐response patients. Statistically significant parameters were selected to deliver receiver operating characteristic curve (ROC) analysis, with stepwise regression constructing optimal prediction models. Key Results A total of 121 achalasia patients were included, of which 10 patients were assigned to the clinical non‐response group. While no significant difference was found in HRM, endoscopy, and barium esophagram metrics, patients in the clinical non‐response group presented higher phase‐specific intrabolus pressure (IBP), increased pressure, and lower distensibility index (DI) of the esophageal body, higher pressure at EGJ, and lower retention ratio under 4D‐HRIM evaluation. The area under the curve (AUC) for predicting poor outcomes using a single 4D‐HRIM metric, such as phase‐specific IBP or DI, ranged from 0.69 to 0.76. The combination of the median IBP at phase 2 and the retention ratio showed the best predictive performance, with an AUC of 0.817. Conclusions and Inferences 4D‐HRIM evaluation could help predict clinical outcomes after POEM in achalasia, thereby enabling us to develop personalized surgical strategies and establish more meticulous postoperative follow‐up plans.
Chen et al. (Thu,) studied this question.