DELTA-IRP AS A NEW HIGH-RESOLUTION MANOMETRY METRIC TO PREDICT THE POSITIVE OUTCOME OF LAPAROSCOPIC HELLER-DOR IN PATIENTS WITH ACHALASIA.

Abstract

Introduction: There is no consensus on the definition of failure after treatment in patients with achalasia. The Eckardt score (ES) is used to define clinical outcomes, but objective metrics are lacking. The aim of this study was to identify if any high-resolution manometry (HRM) parameters may be useful to predict a positive outcome after laparoscopic Heller-Dor (LHD).

Methods: Patients undergoing LHD between 2012-2022 were enrolled. They were divided according to the outcome into success (SG) and failure group (FG). Alongside with the common HRM parameters, we also measured the difference between pre- and postoperative integrated relaxation pressure (∆-IRP). A ROC curve analysis was applied to assess the accuracy of each HRM parameter.

Results: Three-hundred-thirty-six patients (92.3%) were classified in the SG and 28 (7.7%) in the FG. No difference was found in terms of manometric types, symptom duration and history of previous treatments; preoperative lower esophageal sphincter (LES) pressure and IRP were higher in the SG than in the FG (41 vs 35mmHg, p=0.03 and 33 vs 26mmHg, p=0.002, respectively). The postoperative LES metrics were similar between the two groups, except for the ∆-IRP that was higher in the SG (23mmHg, IQR:15-31) than in the FG (14mmHg, IQR:9-17, p=0.0002). At univariable analysis, age, LES preoperative pressure, IRP and ∆-IRP were factors able to predict a positive clinical outcome. At multivariable analysis, the ∆-IRP was the only parameter independently related to clinical success (p<0.01, OR:0.94, CI 5%-95%:0.89-0.99). The ROC curve for the ∆-IRP showed an area under the curve of 0.71, with a threshold value set at 16.5mmHg (sensibility 71%, specificity 70%).

Conclusions: Our data showed that the ∆-IRP with a threshold of 16.5mmHg could represent a new objective tool in order to predict the long-term positive outcome of LHD in patients with esophageal achalasia.