title: Effects of laparoscopic myotomy on the esophageal motility pattern of esophageal achalasia as measured by high-resolution manometry.
abstract: Esophageal achalasia can be classified on the grounds of three distinct manometric patterns that correlate well with final outcome after laparoscopic Heller-Dor myotomy (LHM). No analytical data are available, however, on the postoperative picture and its possible correlation with final outcome. The aims of this study were: (a) to investigate whether manometric patterns change after LHM for achalasia; (b) to ascertain whether postoperative patterns and/or changes can predict final outcome; and (c) to test the hypothesis that the three known patterns represent different stages in the evolution of the disease.
  
  
  
  During the study period, we prospectively enlisted 206 consecutive achalasia patients who were assessed using high-resolution manometry (HRM) before undergoing LHM. Symptoms were scored using a detailed questionnaire. Barium swallow, endoscopy and HRM were performed, before and again 6 months after surgery.
  
  
  
  Preoperative HRM revealed the three known patterns with statistically different esophageal diameters (pattern I having the largest), and patients with pattern I had the highest symptom scores. The surgical treatment failed in 10 cases (4.9%). The only predictor of final outcome was the preoperative manometric pattern (p = 0.01). All patients with pattern I preoperatively had the same pattern afterward, whereas nearly 50% of patients with pattern III before LHM had patterns I or II after surgery. There were no cases showing the opposite trend.
  
  
  
  Neither a change of manometric pattern after surgery nor a patient's postoperative pattern was a predictor of final outcome, whereas preoperative pattern confirmed its prognostic significance. The three manometric patterns distinguishable in achalasia may represent different stages in the disease's evolution, pattern III and pattern I coinciding with the early and final stages of the disease, respectively.
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, School of Medicine, Clinica Chirurgica 3, Policlinico Universitario, 35128, Padua, Italy. renato.salvador@libero.it.
authors.forename: Renato
authors.initials: R
authors.lastname: Salvador
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, School of Medicine, Clinica Chirurgica 3, Policlinico Universitario, 35128, Padua, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Savarino
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, School of Medicine, Clinica Chirurgica 3, Policlinico Universitario, 35128, Padua, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Pesenti
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, School of Medicine, Clinica Chirurgica 3, Policlinico Universitario, 35128, Padua, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Spadotto
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, School of Medicine, Clinica Chirurgica 3, Policlinico Universitario, 35128, Padua, Italy.
authors.forename: Guerrino
authors.initials: G
authors.lastname: Voltarel
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, School of Medicine, Clinica Chirurgica 3, Policlinico Universitario, 35128, Padua, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Capovilla
authors.affiliation: Esophageal and Digestive Tract Surgical Unit, Regional Centre for Esophageal Disease, Veneto Institute of Oncology (IOV IRCCS), Padua, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cavallin
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, School of Medicine, Clinica Chirurgica 3, Policlinico Universitario, 35128, Padua, Italy.
authors.forename: Loredana
authors.initials: L
authors.lastname: Nicoletti
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, School of Medicine, Clinica Chirurgica 3, Policlinico Universitario, 35128, Padua, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Valmasoni
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, School of Medicine, Clinica Chirurgica 3, Policlinico Universitario, 35128, Padua, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Ruol
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, School of Medicine, Clinica Chirurgica 3, Policlinico Universitario, 35128, Padua, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Merigliano
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, School of Medicine, Clinica Chirurgica 3, Policlinico Universitario, 35128, Padua, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Costantini
mesh_terms: D000328:Adult; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005769:Gastrointestinal Motility / Q000502:physiology*; D000074434:Heller Myotomy / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Achalasia; Heller-Dor; Manometric pattern; Myotomy