971 Does Post-Procedure Esophagogastric Junction (EGJ) Distensibility Predict Treatment Success in Newly Diagnosed Achalasia Patients?

Abstract

Introduction: Although initial treatment success rates with pneumatic dilation in achalasia are high, recurrences may occur in more than 50% of patients. Identification of patients in need of re-treatment may be difficult as they are accustomed to a certain level of discomfort. LES pressure ≥10mmHg is considered as an indication for additional therapy but several studies reported a significant proportion of patients with persistent symptoms and low or absent LES pressure. We aimed to study whether post-procedure assessment of esophagogastric junction (EGJ) distensibility can predict treatment success in newly diagnosed achalasia patients. Methods: Eighteen newly diagnosed achalasia patients (10 male, mean age 47.9, range 19-75) underwent 2 pneumatic dilations (PD) with 30and 35mm balloons separated by 1 week. Before and after the 30mm dilation, EGJ distensibility was measured using an endoscopic functional luminal imaging probe (EndoFLIP). Using an EndoFLIP probe with an inflatable bag, EGJ distensibility (cross-sectional area of the diaphragmatic hiatus (CSA)/ pressure within bag during distensions; mm2/mmHg) was measured with 20-, 30-, 40and 50ml distensions. After 3 months patients were assessed by esophageal manometry and with validated symptom questionnaires to determine the Eckardt score, with a score ,4 indicating treatment success. Results: Mean post-procedure EGJ distensibility increased at the 20-, 30, 40and 50ml distention volumes (p,0.05) (Table 1). According to the Eckardt score at 3 months after treatment, 14 out of 18 achalasia patients (77.8%) were considered as having treatment success; treatment failures (n=4) underwent an additional PD with the 40mm balloon. Post-procedure EGJ distensibility of successfully treated patients at 40 and 50ml distention volumes were not significantly higher than in treatment failures (40ml: 3.1±0.5 vs. 2.6±1.2, p=0.69; 50ml: 4.7±0.7 vs. 2.8±1.2, p=0.20). At 3 months after treatment, LES pressure of successfully treated patients was lower than in treatment failures (11±1 vs. 36±12, p=0.13) and a good correlation was found between LES pressure and symptom scores (r=0.88, p,0.001). Post-procedure EGJ distensibility at 40 and 50ml distention volumes correlated poorly with symptom scores at 3 months (40ml: r=-0.10, p=0.70; 50ml: r=-0.26, p=0.37) and modestly with LES-pressure (40ml: r=-0.32, p=0.24; 50ml: r=-0.55, p=0.05). Conclusion: Post-procedure Esophagogastric Junction (EGJ) Distensibility of newly diagnosed achalasia patients improves after pneumatic dilation but is not associated with treatment success after 3 months as compared with symptom scores and LES pressure. Mean EGJ distensibility during volume distentions