title: High-Resolution Impedance Manometry Metrics of the Esophagogastric Junction for the Assessment of Treatment Response in Achalasia.
abstract: OBJECTIVE
  We aimed to evaluate the value of novel high-resolution impedance manometry (HRIM) metrics, bolus flow time (BFT), and esophagogastric junction (EGJ) contractile integral (CI), as well as EGJ pressure (EGJP) and the integrated relaxation pressure (IRP), as indicators of treatment response in achalasia.
  
  
  METHODS
  We prospectively evaluated 75 patients (ages 19-81, 32 female) with achalasia during follow-up after pneumatic dilation or myotomy with Eckardt score (ES), timed-barium esophagram (TBE), and HRIM. Receiver-operating characteristic (ROC) curves for good symptomatic outcome (ES≤3) and good radiographic outcome (TBE column height at 5 min<5 cm) were generated for each potential predictor of treatment response (EGJP, IRP, BFT, and EGJ-CI).
  
  
  RESULTS
  Follow-up occurred at a median (range) 12 (3-291) months following treatment. A total of 49 patients had good symptomatic outcome and 46 had good radiographic outcome. The area-under-the-curves (AUCs) on the ROC curve for symptomatic outcome were 0.55 (EGJP), 0.62 (IRP), 0.77 (BFT) and 0.56 (EGJ-CI). The AUCs for radiographic outcome were 0.64 (EGJP), 0.48 (IRP), 0.73 (BFT), and 0.65 (EGJ-CI). Optimal cut-points were determined as 11 mm Hg (EGJP), 12 mm Hg (IRP), 0 s (BFT), and 30 mm Hg•cm (EGJ-CI) that provided sensitivities/specificities of 57%/46% (EGJP), 65%/58% (IRP), 78%/77% (BFT), and 53%/62% (EGJ-CI) to predict symptomatic outcome and 57%/66% (EGJP), 57%/41% (IRP), 76%/69% (BFT), and 57%/66% (EGJ-CI) to predict radiographic outcome.
  
  
  CONCLUSIONS
  BFT, a novel HRIM metric, provided an improved functional assessment over manometric measures of EGJP, IRP, and EGJ-CI at follow-up after achalasia treatment and may help direct clinical management.
authors.affiliation: Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Dustin A
authors.initials: DA
authors.lastname: Carlson
authors.affiliation: Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Zhiyue
authors.initials: Z
authors.lastname: Lin
authors.affiliation: Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kahrilas
authors.affiliation: Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Joel
authors.initials: J
authors.lastname: Sternbach
authors.affiliation: Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Hungness
authors.affiliation: Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Nathaniel J
authors.initials: NJ
authors.lastname: Soper
authors.affiliation: Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Balla
authors.affiliation: Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Listernick
authors.affiliation: Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Tye
authors.affiliation: Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Ritter
authors.affiliation: Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Jenna
authors.initials: J
authors.lastname: Craft
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Jody D
authors.initials: JD
authors.lastname: Ciolino
authors.affiliation: Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Pandolfino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001466:Barium Sulfate; D003287:Contrast Media; D004106:Dilatation / Q000379:methods*; D017097:Electric Impedance; D004931:Esophageal Achalasia / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D049630:Esophageal Sphincter, Lower / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D004943:Esophagogastric Junction / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005769:Gastrointestinal Motility; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D011859:Radiography; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate