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High resolution manometry sub-classification of Achalasia: does it really matter?

Does Achalasia sub-classification matter?

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Abstract

Background

Three variants of Achalasia have been described using high-resolution esophageal manometry (HRM). While manometrically distinct, their clinical significance has yet to be established. Our objective was to compare the outcome after myotomy in patients with these Achalasia subtypes.

Methods

A retrospective chart review was performed to identify patients with Achalasia who had HRM and who underwent Heller myotomy or Per oral endoscopic myotomy (POEM). Symptoms and esophageal clearance by timed barium study were compared before and after treatment.

Results

We identified 49 patients, 21 males and 28 females, with a median age of 52 years. The primary symptom in all patients was dysphagia, with a median duration of 4 years (range 4 months–50 years). By HRM, ten patients (20 %) were classified as Type I, 30 (61 %) as Type II, and 9 (18 %) as Type III. At a median follow-up of 16 months after myotomy (range 1–63 months), the median Eckardt score was zero and was similar across subtypes. Relief of dysphagia was also similar across subtypes (80 % of Type I, 93 % of Type II and 89 % of Type III).

On pre-treatment timed barium study, no patient had complete emptying at 1 or 5 min. After myotomy, complete emptying occurred within 1 min in 50 % (20/40) and within 5 min in 60 % (24/40) and was similar across groups.

Conclusion

Myotomy for Achalasia results in excellent symptomatic outcome and improvement in esophageal clearance. There was no difference among the described HRM Achalasia variants. This calls into question the clinical utility of Achalasia sub-classification and affirms the benefit of myotomy for this disease.

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Acknowledgments

None.

Disclosures

Drs. Greene, Chang, Oh, Worrell, and Hagen have nothing to disclose.

Dr. DeMeester is a consultant for Davol, Gore, Novadaq and C2 Therapeutics, none of which are relevant to this work.

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Authors and Affiliations

  1. Keck School of Medicine of the University of Southern California, 1510 San Pablo St, HCCI, Suite 514, Los Angeles, CA, 90033, USA

    Christina L. Greene, Erica J. Chang, Daniel S. Oh, Stephanie G. Worrell, Jeffrey A. Hagen & Steven R. DeMeester

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  1. Christina L. Greene
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  2. Erica J. Chang
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  3. Daniel S. Oh
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  4. Stephanie G. Worrell
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  5. Jeffrey A. Hagen
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  6. Steven R. DeMeester
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Corresponding author

Correspondence to Daniel S. Oh.

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Greene, C.L., Chang, E.J., Oh, D.S. et al. High resolution manometry sub-classification of Achalasia: does it really matter?. Surg Endosc 29, 1363–1367 (2015). https://doi.org/10.1007/s00464-014-3804-3

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  • DOI: https://doi.org/10.1007/s00464-014-3804-3

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