High-Resolution Impedance Manometry Metrics of the Esophagogastric Junction for the Assessment of Treatment Response in Achalasia
| Autor: | Peter J. Kahrilas, Zoe Listernick, Katherine A. Ritter, Michelle Balla, Michael Y. Tye, John E. Pandolfino, Jody D. Ciolino, Jenna Craft, Dustin A. Carlson, Zhiyue Lin, Nathaniel J. Soper, Joel M. Sternbach, Eric S. Hungness |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Treatment response Manometry Contrast Media High resolution Achalasia digestive system Esophageal Sphincter Lower Article Young Adult 03 medical and health sciences 0302 clinical medicine Electric Impedance otorhinolaryngologic diseases Humans Medicine Prospective Studies Esophagogastric junction Electrical impedance Aged Aged 80 and over Hepatology business.industry Gastroenterology Middle Aged medicine.disease Dilatation digestive system diseases Esophageal Achalasia Radiography Treatment Outcome ROC Curve Area Under Curve 030220 oncology & carcinogenesis Female 030211 gastroenterology & hepatology Esophagogastric Junction Radiology Barium Sulfate Gastrointestinal Motility business Follow-Up Studies |
| Zdroj: | American Journal of Gastroenterology. 111:1702-1710 |
| ISSN: | 0002-9270 |
| Popis: | We aimed to evaluate the value of novel high-resolution impedance manometry (HRIM) metrics, bolus flow time (BFT), and esophagogastric junction (EGJ) contractile integral (CI), as well as EGJ pressure (EGJP) and the integrated relaxation pressure (IRP), as indicators of treatment response in achalasia.We prospectively evaluated 75 patients (ages 19-81, 32 female) with achalasia during follow-up after pneumatic dilation or myotomy with Eckardt score (ES), timed-barium esophagram (TBE), and HRIM. Receiver-operating characteristic (ROC) curves for good symptomatic outcome (ES≤3) and good radiographic outcome (TBE column height at 5 min5 cm) were generated for each potential predictor of treatment response (EGJP, IRP, BFT, and EGJ-CI).Follow-up occurred at a median (range) 12 (3-291) months following treatment. A total of 49 patients had good symptomatic outcome and 46 had good radiographic outcome. The area-under-the-curves (AUCs) on the ROC curve for symptomatic outcome were 0.55 (EGJP), 0.62 (IRP), 0.77 (BFT) and 0.56 (EGJ-CI). The AUCs for radiographic outcome were 0.64 (EGJP), 0.48 (IRP), 0.73 (BFT), and 0.65 (EGJ-CI). Optimal cut-points were determined as 11 mm Hg (EGJP), 12 mm Hg (IRP), 0 s (BFT), and 30 mm Hg•cm (EGJ-CI) that provided sensitivities/specificities of 57%/46% (EGJP), 65%/58% (IRP), 78%/77% (BFT), and 53%/62% (EGJ-CI) to predict symptomatic outcome and 57%/66% (EGJP), 57%/41% (IRP), 76%/69% (BFT), and 57%/66% (EGJ-CI) to predict radiographic outcome.BFT, a novel HRIM metric, provided an improved functional assessment over manometric measures of EGJP, IRP, and EGJ-CI at follow-up after achalasia treatment and may help direct clinical management. |
| Databáze: | OpenAIRE |
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