Title: Clinical usefulness of esophagogastric junction distensibility measurement in patients with achalasia before and after peroral endoscopic myotomy
Abstract: Background/Aims: This study aimed to determine the clinical efficacy of measuring the esophagogastric junction (EGJ) distensibility index (DI) in patients with achalasia before and after peroral endoscopic myotomy (POEM).Materials and Methods: Retrospective data were collected from 195 patients who underwent POEM from November 2014 to November 2017 at our clinic.The Eckardt score, high-resolution manometry, and EGJ distensibility were measured before and six months after POEM.Treatment failure was defined as a postprocedure Eckardt score >3 or patients who underwent repeat POEM.Results: The DI (mm2/mmHg) before and after POEM was 3. 42±3.55 and 11.57±6.64,respectively (p<0.01).There was no difference in the DI between achalasia subtypes I, II, and III (11.45±6.24versus 15.49±11.53versus 13.27±9.49,p=0.22) or previous treatment history (15.39±10.85versus 11.10±7.25,p=0.20).The DI was higher in patients with reflux esophagitis after POEM, but the difference was not significant (13.59±7.15versus 12.54±10.9,p=0.571).Conclusion: This study showed that EGJ distensibility measurement is useful to assess post-POEM outcomes.These findings suggest that the functional lumen imaging probe may be a useful method for assessing clinical efficacy of POEM in patients with achalasia.However, this is a costly procedure that requires experience.