Impedance planimetry values for predicting clinical response following peroral endoscopic myotomy.

Autor:	Moran RA; Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, United States.; Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States., Brewer Gutierrez OI; Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, United States., Rahden B; Department of Surgery Paracelsus, Medical Private Unviersity, Salzburg, Austria., Chang K; Department of Gastroenterology, University of California Irvine Health, Irvine, California, United States., Ujiki M; Department of Gastroenterology, North Shore University Health System, Evanston, Illinois, United States., Yoo IK; Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea., Gulati S; Department of Gastroenterology, King's College Hospital, London, United Kingdom., Romanelli J; Department of Gastroenterology, University of Massachusetts Medical School/Baystate, Baystate Medical Center, Springfield, Massachusetts, United States., Al-Nasser M; Department of Surgery Paracelsus, Medical Private Unviersity, Salzburg, Austria., Shimizu T; Department of Gastroenterology, University of California Irvine Health, Irvine, California, United States., Hedberg MH; Department of Gastroenterology, University of Chicago Medical Center, Chicago, Illinois, United States., Cho JY; Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea., Hayee B; Department of Gastroenterology, King's College Hospital, London, United Kingdom., Desilets D; Department of Gastroenterology, University of Massachusetts Medical School/Baystate, Baystate Medical Center, Springfield, Massachusetts, United States., Filser J; Department of Surgery, InnKlinikum Altötting, Altötting, Germany., Fortinsky K; Department of Gastroenterology, University of California Irvine Health, Irvine, California, United States., Haji A; Department of Gastroenterology, King's College Hospital, London, United Kingdom., Fayad L; Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States., Sanaei O; Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States., Dbouk M; Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States., Kumbhari V; Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States., Wolf BJ; Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States., Elmunzer BJ; Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, United States., Khashab MA; Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States.
Jazyk:	angličtina
Zdroj:	Endoscopy [Endoscopy] 2021 Jun; Vol. 53 (6), pp. 570-577. Date of Electronic Publication: 2020 Nov 04.
DOI:	10.1055/a-1268-7713
Abstrakt:	Background: There is growing interest in developing impedance planimetry as a tool to enhance the clinical outcomes for endoscopic and surgical management of achalasia. The primary aim of this study was to determine whether impedance planimetry measurements can predict clinical response and reflux following peroral endoscopic myotomy (POEM). Methods: A multicenter cohort study of patients with achalasia undergoing POEM was established from prospective databases and retrospective chart reviews. Patients who underwent impedance planimetry before and after POEM were included. Clinical response was defined as an Eckardt score of ≤ 3. Tenfold cross-validated area under curve (AUC) values were established for the different impedance planimetry measurements associated with clinical response and reflux development. Results: Of the 290 patients included, 91.7 % (266/290) had a clinical response and 39.4 % (108/274) developed reflux following POEM. The most predictive impedance planimetry measurements for a clinical response were: percent change in cross-sectional area (%ΔCSA) and percent change in distensibility index (%ΔDI), with AUCs of 0.75 and 0.73, respectively. Optimal cutoff values for %ΔCSA and %ΔDI to determine a clinical response were a change of 360 % and 272 %, respectively. Impedance planimetry values were much poorer at predicting post-POEM reflux, with AUCs ranging from 0.40 to 0.62. Conclusion: Percent change in CSA and distensibility index were the most predictive measures of a clinical response, with a moderate predictive ability. Impedance planimetry values for predicting reflux following POEM showed weak predictive capacity. Competing Interests: B. Joseph Elmunzer is a consultant for Takeda Pharmaceuticals. Mouen A. Khashab is a consultant for Boston Scientific, Olympus, and Medtronic, and is also on the medical advisory board for Boston Scientific and Olympus. Vivek Kumbhari is a consultant for Apollo Endosurgery, Boston Scientific, Medtronic, and ReShape Life Science. Bu Hayee is a consultant for Apollo Endosurgery, Boston Scientific, Fuji, Medtronic, Obalon, Pentax Medical, and ReShape Life Sciences. All other authors declare that they have no conflicts of interest. (Thieme. All rights reserved.)
Databáze:	MEDLINE
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