Journal of pediatric gastroenterology and nutrition · 2026
Pressure-flow analysis following peroral endoscopic myotomy in pediatric achalasia: Novel insights into esophageal emptying.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Tambucci Renato, Chiarazzo Giulia, Rommel Nathalie, Imondi Chiara, Caldaro Tamara, De Angelis Paola, Balassone Valerio, OPBG CHENDO Group
Аннотация
OBJECTIVE: Achalasia is a rare esophageal motility disorder in children. Peroral endoscopic myotomy (POEM) has emerged as a promising treatment yet standardized post-treatment evaluation remains lacking. While high-resolution manometry (HRM) is the diagnostic gold standard, its role post-treatment is limited. Pressure-flow analysis (PFA), derived from high-resolution impedance manometry (HRIM), offers a novel approach to assessing bolus transport and esophageal emptying. We aimed to evaluate PFA metrics in pediatric achalasia patients before and after POEM and assess its utility in monitoring post-treatment outcomes.
METHODS: This retrospective study included 13 pediatric patients (8 males; mean age 13.3 ± 3.38 years) with achalasia treated with POEM at a tertiary referral center between 2016 and 2024. Inclusion required both pre- and post-POEM HRIM. HRM metrics were analyzed using Chicago Classification version 4.0 (CCv4.0), while PFA parameters, including impedance ratio (IR) and distension pressure during emptying (DPE), were calculated using the Swallow Gateway™ platform.
RESULTS: All patients experienced symptomatic improvement, with the median Eckardt Symptom Score (ESS) significantly decreasing from 6 (range 2-10) to 0 (range 0-2; p = 0.0002). Following POEM, there was a significant reduction in median integrated relaxation pressure (IRP4s: 35.6-15.8 mmHg; p = 0.0002), although 7 out of 13 patients (53.8%) achieved IRP4s values below the upper limit of normal. Additionally, significant decreases were observed in median IR (0.65-0.52, p = 0.0002) and median DPE (28.9-17.3 mmHg, p = 0.0171). Subgroup analysis showed that improvements in IR and DPE occurred regardless of IRP4s normalization.
CONCLUSION: PFA enhances post-POEM evaluation in pediatric achalasia, offering an objective assessment of esophageal emptying beyond conventional pressure metrics. This study supports the potential role of PFA in post-treatment follow-up, warranting further validation in larger cohorts.
METHODS: This retrospective study included 13 pediatric patients (8 males; mean age 13.3 ± 3.38 years) with achalasia treated with POEM at a tertiary referral center between 2016 and 2024. Inclusion required both pre- and post-POEM HRIM. HRM metrics were analyzed using Chicago Classification version 4.0 (CCv4.0), while PFA parameters, including impedance ratio (IR) and distension pressure during emptying (DPE), were calculated using the Swallow Gateway™ platform.
RESULTS: All patients experienced symptomatic improvement, with the median Eckardt Symptom Score (ESS) significantly decreasing from 6 (range 2-10) to 0 (range 0-2; p = 0.0002). Following POEM, there was a significant reduction in median integrated relaxation pressure (IRP4s: 35.6-15.8 mmHg; p = 0.0002), although 7 out of 13 patients (53.8%) achieved IRP4s values below the upper limit of normal. Additionally, significant decreases were observed in median IR (0.65-0.52, p = 0.0002) and median DPE (28.9-17.3 mmHg, p = 0.0171). Subgroup analysis showed that improvements in IR and DPE occurred regardless of IRP4s normalization.
CONCLUSION: PFA enhances post-POEM evaluation in pediatric achalasia, offering an objective assessment of esophageal emptying beyond conventional pressure metrics. This study supports the potential role of PFA in post-treatment follow-up, warranting further validation in larger cohorts.