Journal of Gastrointestinal Surgery

, Volume 14, Issue 11, pp 1635–1645

The Preoperative Manometric Pattern Predicts the Outcome of Surgical Treatment for Esophageal Achalasia

  • Renato Salvador
  • Mario Costantini
  • Giovanni Zaninotto
  • Tiziana Morbin
  • Christian Rizzetto
  • Lisa Zanatta
  • Martina Ceolin
  • Elena Finotti
  • Loredana Nicoletti
  • Gianfranco Da Dalt
  • Francesco Cavallin
  • Ermanno Ancona
2010 SSAT Plenary Presentation

DOI: 10.1007/s11605-010-1318-4

Cite this article as:
Salvador, R., Costantini, M., Zaninotto, G. et al. J Gastrointest Surg (2010) 14: 1635. doi:10.1007/s11605-010-1318-4

Abstract

Background

A new manometric classification of esophageal achalasia has recently been proposed that also suggests a correlation with the final outcome of treatment. The aim of this study was to investigate this hypothesis in a large group of achalasia patients undergoing laparoscopic Heller–Dor myotomy.

Methods

We evaluated 246 consecutive achalasia patients who underwent surgery as their first treatment from 2001 to 2009. Patients with sigmoid-shaped esophagus were excluded. Symptoms were scored and barium swallow X-ray, endoscopy, and esophageal manometry were performed before and again at 6 months after surgery. Patients were divided into three groups: (I) no distal esophageal pressurization (contraction wave amplitude <30 mmHg); (II) rapidly propagating compartmentalized pressurization (panesophageal pressurization >30 mmHg); and (III) rapidly propagating pressurization attributable to spastic contractions. Treatment failure was defined as a postoperative symptom score greater than the 10th percentile of the preoperative score (i.e., >7).

Results

Type III achalasia coincided with a longer overall lower esophageal sphincter (LES) length, a lower symptom score, and a smaller esophageal diameter. Treatment failure rates differed significantly in the three groups: I = 14.6% (14/96), II = 4.7% (6/127), and III = 30.4% (7/23; p = 0.0007). At univariate analysis, the manometric pattern, a low LES resting pressure, and a high chest pain score were the only factors predicting treatment failure. At multivariate analysis, the manometric pattern and a LES resting pressure <30 mmHg predicted a negative outcome.

Conclusion

This is the first study by a surgical group to assess the outcome of surgery in 3 manometric achalasia subtypes: patients with panesophageal pressurization have the best outcome after laparoscopic Heller–Dor myotomy.

Keywords

AchalasiaManometric patternHeller–DorConventional manometryHigh resolutionManometry

Copyright information

© The Society for Surgery of the Alimentary Tract 2010

Authors and Affiliations

  • Renato Salvador
    • 1
  • Mario Costantini
    • 1
  • Giovanni Zaninotto
    • 2
  • Tiziana Morbin
    • 1
  • Christian Rizzetto
    • 1
  • Lisa Zanatta
    • 1
  • Martina Ceolin
    • 1
  • Elena Finotti
    • 1
  • Loredana Nicoletti
    • 1
  • Gianfranco Da Dalt
    • 1
  • Francesco Cavallin
    • 3
  • Ermanno Ancona
    • 1
  1. 1.Department of Surgical and Gastroenterological Sciences (Clinica Chirurgica I), School of MedicineUniversity of PadovaPadovaItaly
  2. 2.Department of General SurgerySS Giovanni e Paolo HospitalVeniceItaly
  3. 3.Surgical OncologyIstituto Oncologico Veneto, IOV-IRCCSPadovaItaly