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Three-Dimensional High-Resolution Esophageal Manometry Study of the Esophagogastric Junction in Patients with Achalasia

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Abstract

Background

A novel three-dimensional high-resolution esophageal manometry provides a dynamic 360° representation of the pressure at the esophagogastric junction.

Aims

To describe the three-dimensional high-resolution esophageal manometry patterns of achalasia.

Methods

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.

Results

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.

Conclusions

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.

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Abbreviations

CD:

Crural diaphragm

CT:

Computerized tomography

EGJ:

Esophagogastric junction

LES:

Lower esophageal sphincter

IRP:

Integrated relaxation pressure

3D-HRM:

Three-dimensional high-resolution manometry

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Acknowledgments

The authors thank the Medtronic Company for gratuitously providing the 3D high-resolution manometry probe.

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Authors and Affiliations

  1. Gastroenterology Department, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, 27 rue du Faubourg Saint Jacques, 75010, Paris, France

    Marie-Anne Guillaumot, Chloé Léandri, Sarah Leblanc, Romain Coriat, Frédéric Prat, Stanislas Chaussade & Maximilien Barret

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  1. Marie-Anne Guillaumot
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  2. Chloé Léandri
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  3. Sarah Leblanc
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  4. Romain Coriat
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  6. Stanislas Chaussade
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  7. Maximilien Barret
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Contributions

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.

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Correspondence to Marie-Anne Guillaumot.

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Guillaumot, MA., Léandri, C., Leblanc, S. et al. Three-Dimensional High-Resolution Esophageal Manometry Study of the Esophagogastric Junction in Patients with Achalasia. Dig Dis Sci 65, 1092–1098 (2020). https://doi.org/10.1007/s10620-019-05824-y

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  • DOI: https://doi.org/10.1007/s10620-019-05824-y

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