Costantini Andrea, Pittacolo Matteo, Nezi Giulia, Capovilla Giovanni, Costantini Mario, Vittori Arianna, Santangelo Matteo, Provenzano Luca, Nicoletti Loredana, Forattini Francesca, Moletta Lucia, Valmasoni Michele, Savarino Edoardo V, Salvador Renato
Unit of General Surgery 1, Department of Surgery, Oncology, and Gastroenterology, School of Medicine, University of Padova, Padova, Italy.
Unit of General Surgery 1, Department of Surgery, Oncology, and Gastroenterology, School of Medicine, University of Padova, Padova, Italy; Unit of Gastroenterology, Department of Surgery, Oncology, and Gastroenterology, School of Medicine, University of Padova, Padova, Italy.
J Gastrointest Surg. 2025 Feb;29(2):101928. doi: 10.1016/j.gassur.2024.101928. Epub 2025 Jan 2.
There is no consensus on the definition of failure after treatment in patients with achalasia. The Eckardt score is used to define clinical outcomes. However, objective metrics are lacking. This study aimed to identify whether any high-resolution manometry (HRM) parameters may be useful in predicting a positive outcome after laparoscopic Heller-Dor (LHD).
Patients who underwent LHD between 2012 and 2022 were enrolled. The patients were divided according to the outcome: the success group (SG) and the failure group (FG). In addition to the common HRM parameters, we measured the difference between pre- and postoperative integrated relaxation pressures (∆-IRPs). A receiver operating characteristic (ROC) curve analysis was performed to assess the accuracy of each HRM parameter.
Of note, 336 patients (92.3%) were classified in the SG, and 28 patients (7.7%) were classified 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 35 mm Hg [P =.03] and 33 vs 26 mm Hg [P =.002], respectively). The postoperative LES metrics were similar between the 2 groups, except for the ∆-IRP that was higher in the SG (23 mm Hg [IQR, 15-31]) than in the FG (14 mm Hg [IQR, 9-17]) (P =.0002). In the univariate analysis, age, LES preoperative pressure, IRP, and ∆-IRP were factors able to predict a positive clinical outcome. In the multivariate analysis, the ∆-IRP was the only parameter independently related to clinical success (odds ratio, 0.94; 5%-95% CI, 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 16.5 mm Hg (sensibility of 71% and specificity of 70%).
Our data showed that the ∆-IRP with a threshold of 16.5 mm Hg could represent a new objective tool for predicting the long-term positive outcome of LHD in patients with esophageal achalasia.
贲门失弛缓症患者治疗后失败的定义尚无共识。埃卡德特评分用于定义临床结局。然而，缺乏客观指标。本研究旨在确定高分辨率测压（HRM）参数是否有助于预测腹腔镜Heller-Dor术（LHD）后的阳性结局。
纳入2012年至2022年间接受LHD的患者。根据结局将患者分为成功组（SG）和失败组（FG）。除了常见的HRM参数外，我们还测量了术前和术后综合松弛压之间的差异（∆-IRP）。进行受试者工作特征（ROC）曲线分析以评估每个HRM参数的准确性。
值得注意的是，336例患者（92.3%）被归类为SG组，28例患者（7.7%）被归类为FG组。在测压类型、症状持续时间和既往治疗史方面未发现差异。SG组术前食管下括约肌（LES）压力和IRP高于FG组（分别为41 vs 35 mmHg [P = 0.03]和33 vs 26 mmHg [P = 0.002]）。两组术后LES指标相似，但SG组的∆-IRP高于FG组（23 mmHg [IQR，15 - 31]）（14 mmHg [IQR，9 - 17]）（P = 0.0002）。在单因素分析中，年龄、LES术前压力、IRP和∆-IRP是能够预测阳性临床结局的因素。在多因素分析中，∆-IRP是唯一与临床成功独立相关的参数（比值比，0.94；5% - 95% CI，0.89 - 0.99）。∆-IRP的ROC曲线下面积为0.71，阈值设定为16.5 mmHg（敏感性为71%，特异性为70%）。
我们的数据表明，阈值为16.5 mmHg的∆-IRP可代表一种新的客观工具，用于预测食管贲门失弛缓症患者LHD的长期阳性结局。
