Three-Dimensional High-Resolution Esophageal Manometry Study of the Esophagogastric Junction in Patients with Achalasia
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A novel three-dimensional high-resolution esophageal manometry provides a dynamic 360° representation of the pressure at the esophagogastric junction.
To describe the three-dimensional high-resolution esophageal manometry patterns of achalasia.
We retrospectively included all consecutive patients who underwent three-dimensional high-resolution esophageal manometry before and after treatment (pneumatic dilatation or per-oral endoscopic myotomy) for achalasia between November 2016 and July 2017. The distribution of the pressures at the esophagogastric junction on three-dimensional high-resolution esophageal manometry was determined.
Eighteen patients were included. Mean integrated relaxation pressure was 20.7 mmHg, and median (range) Eckardt score was 7 (4–10). Nine patients were treated by pneumatic dilatation and seven by myotomy. Nine patients underwent three-dimensional high-resolution esophageal manometry after treatment. Before treatment, the esophagogastric junction pressure distribution was best observed at end expiration and during the 4 s of the integrated relaxation pressure measurement. During the integrated relaxation pressure, the lower esophageal sphincter was asymmetric in 12 patients with a high-pressure zone between the left and the posterior side of the esophagogastric junction. After treatment, five patients had a residual high-pressure point on the left or the posterior side of the esophagogastric junction.
Three-dimensional high-resolution esophageal manometry allows a simple assessment of the pressure topography at the EGJ. In patients with achalasia, we found the esophagogastric junction pressure to be asymmetric with a peak pressure on the greater curvature side. Three-dimensional high-resolution esophageal manometry has the potential to guide initial and redo treatments.
KeywordsAchalasia High-resolution esophageal manometry 3D-HRM Three-dimensional esophageal manometry Esophagogastric junction Functional morphology Pressure profile
Lower esophageal sphincter
Integrated relaxation pressure
Three-dimensional high-resolution manometry
The authors thank the Medtronic Company for gratuitously providing the 3D high-resolution manometry probe.
M-AG performed the 3D-HRM, collected the data, and wrote the article. CL performed the 3D-HRM. MB analyzed the data, designed the research study, and wrote the paper. SL, RC, FP, and SC made significant comments and modifications to the manuscript.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 3.Mittal RK, Zifan A, Kumar D, Ledgerwood-Lee M, Ruppert E, Ghahremani G. Functional morphology of the lower esophageal sphincter and crural diaphragm determined by three-dimensional high-resolution esophago-gastric junction pressure profile and CT imaging. Am J Physiol Gastrointest Liver Physiol. 2017;313:G212–G219.CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Mattioli S, Pilotti V, Felice V, Di Simone MP, D’Ovidio F, Gozzetti G. Intraoperative study on the relationship between the lower esophageal sphincter pressure and the muscular components of the gastro-esophageal junction in achalasic patients. Ann Surg. 1993;218:635–639.CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Oelschlager BK, Chang L, Pellegrini CA. Improved outcome after extended gastric myotomy for achalasia. Arch Surg Chic Ill. 1960;2003:490–495.Google Scholar