Robert A Moran1,2, Olaya I Brewer Gutierrez1, Burkhard Rahden3, Kenneth Chang4, Michael Ujiki5, In Kyung Yoo6, Shraddha Gulati7, John Romanelli8, Mohammed Al-Nasser3, Toshitaka Shimizu4, Mason H Hedberg9, Joo Young Cho6, Bu Hayee7, David Desilets8, Jörg Filser10, Kyle Fortinsky4, Amyn Haji7, Lea Fayad2, Omid Sanaei2, Mohamad Dbouk2, Vivek Kumbhari2, Bethany J Wolf11, B Joseph Elmunzer1, Mouen A Khashab2. 1. Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, United States. 2. Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States. 3. Department of Surgery Paracelsus, Medical Private Unviersity, Salzburg, Austria. 4. Department of Gastroenterology, University of California Irvine Health, Irvine, California, United States. 5. Department of Gastroenterology, North Shore University Health System, Evanston, Illinois, United States. 6. Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea. 7. Department of Gastroenterology, King's College Hospital, London, United Kingdom. 8. Department of Gastroenterology, University of Massachusetts Medical School/Baystate, Baystate Medical Center, Springfield, Massachusetts, United States. 9. Department of Gastroenterology, University of Chicago Medical Center, Chicago, Illinois, United States. 10. Department of Surgery, InnKlinikum Altötting, Altötting, Germany. 11. Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States.
Abstract
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. Thieme. All rights reserved.
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. Thieme. All rights reserved.
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