- Email: [email protected]
Short-Term Outcome of Per Oral Endoscopic Myotomy Versus Endoscopic Pneumatic Dilation
Mo1495
USA) achalasia balloon dilator. Two patients required a second dilation with 35 mm balloon for symptomatic relief. In the PD group, overall satisfaction score was 7.9 with a 10-month average follow up. In the bougie group, (average number of bougie treatments 1.8) overall satisfaction score was 7.7 with an 8-month average follow up. In the PD group, total score for symptom frequency and severity assessed via the Brief Esophageal Dysphagia Questionnaire was 8.14, whereas the total score of the BD group was 8.5. Conclusion: TBE can be a useful tool in determining which patients would benefit from PD versus BD. Similar to achalasia, patients with a standing barium column should undergo PD as first line therapy. However in patients with normal liquid emptying on TBE, BD is a reasonable first therapy. Using this selection criteria, there is no significant difference in dysphagia severity (p=0.91) or overall satisfaction (p=0.87) in EGJOO patients undergoing treatment with pneumatic dilation versus bougie dilation. Reference * Taft, T. H., Riehl, M., Sodikoff, J. B., Kahrilas, P. J., Keefer, L., Doerfler, B. and Pandolfino, J. E. (2016), Development and validation of the brief esophageal dysphagia questionnaire. Neurogastroenterol. Motil.. doi:10.1111/ nmo.12889
AGA Abstracts
IDENTIFICATION OF HIATUS HERNIA BY HIGH RESOLUTION MANOMETRY AND ENDOSCOPY IN PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE Antoni Stadnicki, Józef Kurek, Ewa Klimacka-Nawrot, Malgorzata Bozek, Katarzyna Bilnik Background. Current data related to accuracy in diagnosing of hiatus hernia by high resolution manometry (HRM) and upper endoscopy is equivocal. This study was aimed to compare the value of HRM and endoscopy in detecting sliding hiatus hernia in patients with gastroesophageal reflux disease. Material and Methods. Sensitivity and specificity of HRM and endoscopy were assessed in 31 patients (20 females; mean age 48.2) who were qualified for Nissen fundoplication. Intraoperative diagnosis of hiatus hernia was the gold standard. Manometric protocol included 10 consecutive swallows of 10 ml of water. Manometrically data analysis was done with esophageal pressure topography according to the Chicago Classification. Results. Twenty nine patients out of 31 were found to have sliding hiatus hernia during surgery. Fourteen patients had manometric criteria for hiatus hernia, while 19 patients were found to have hiatus hernia by upper endoscopy before surgery. In HRM there were no false positive results, although 15 false negative results were shown, thus specificity and sensitivity of HRM in detecting hiatus hernia were 100% and 48% respectively. In endoscopy false positive data was observed in one patients, whereas false negative results were found in 10 patients indicating specificity 50% and sensitivity 66 % of endoscopy for identification of hiatus hernia. False negative results (sensitivity) not significantly different as compared HMR and endoscopy (52% vs. 34% respectively, p= 0.29). In addition, no significant discordance (using McNemar's test) was found between two methods (p=0.58). Conclusions. Due to poor sensitivity both high resolution manometry and upper endoscopy are not reliable tools to diagnose sliding hiatus hernia in patients with gastroesophageal reflux. However, high resolution manometry has a good specificity and ability to rule out sliding hiatus hernia.
Mo1496 CHANGE IN THE INTERSTITIAL CELLS OF CAJAL AND NNOS POSITIVE NEURONAL CELLS WITH AGING IN THE ESOPHAGUS OF F344 RATS Nayoung Kim, Hee Jin Kim, Dong Ho Lee
Mo1498
Background and Aims: Previous human and animal studies suggested that the esophageal motility function deteriorates in the elderly. However, the aging-associated structural and molecular changes in esophagus have not yet been established. The aim of this study was to evaluate the changes of morphology, interstitial cell of Cajal (ICC) and neuronal nitric oxide synthase (nNOS)-positive neuronal cell in the esophagus of F344 rat at different ages (6-, 31-, 74-wk and 2-yr). Methods: The esophagus of Fischer 344 rats at four different ages (6, 31, 74 weeks, and 2 years) was studied (each, n = 6-10). The area of lamina propria and endomysium (a connective tissue surrounding each muscle cells) was calculated as a percentage of the total mucosa and muscle area. The immunoreactivity of c-Kit, nNOS and protein gene product 9.5 (PGP 9.5, general neuronal marker) was counted after immunohistochemistry. Expression of c-kit, stem cell factor (SCF, a ligand of c-Kit), PGP 9.5 and nNOS mRNA was also measured by reverse transcriptase-polymerase chain reaction, and expression of c-kit and nNOS protein was detected by Western blot analysis. Results: The lamina propria area was increased significantly in 2-year-old rats compared with 6-week-old rats (P=0.005). The endomysium area of longitudinal muscle markedly decreased with aging (6 week vs 2 year, P <0.001), while endomysium areas of circular muscle did not significantly decrease (6 week vs 2 year, P=0.135). The densities of c-kit-immunoreactive ICCs and nNOSimmunoreactive neuronal cells were significantly decreased in 2-year-old rats compared with 6-week-old rats (both P <0.05), but there was no significant change of the density of PGP 9.5-immunopositive cells with aging (6 week vs 2 year, P=0.754). The expressions of c-kit, SCF and nNOS mRNA were significantly decreased in 2- year-old rats compared with 6week-old rats (c-kit, P=0.002; SCF, P=0.012; nNOS, P=0.009), while the decrease of PGP 9.5 mRNA expression was not significant with aging (6 week vs 2 year, P=0.123). Western blot analysis showed significant decrease of nNOS expression in 2- year-old rats compared with 6-week-rats (P=0.008), but the decrease of c-Kit protein expression was not significant (6 week vs 2 year, P=0.247). Conclusions: The increase of lamina propria area and the decrease of endomysium, c-kit, SCF and NOS expression with relatively preserved total enteric nervous system in rat esophagus may explain the aging-associated esophageal dysmotility.
SHORT-TERM OUTCOME OF PER ORAL ENDOSCOPIC MYOTOMY VERSUS ENDOSCOPIC PNEUMATIC DILATION Xiaohong Sun, Zhifeng Wang, Qingwei Jiang, Xi Wu, Tao Guo, Fang Yao, Meiyun Ke Background and aim:Achalasia is the most common primary motility disorder of esophagus and characterized by impaired deglutitive relaxation of the lower esophageal sphincter due to loss of inhibitory neurons ofmyenteric plexus. The aim of this study is to compare outcome of per oral endoscopic myotomy (POEM) and pneumatic dilation (PD) for patients with achalasia. Methods:This prospective study is involved untreated patient with achalasia aged 18 years-old and moreand unlimited genderin sequence. At first, doctors introduced the two therapies of POEM and PDfor patients in detail and then the patients would choose either POEM or PD by themselves. The symptoms(including dysphagia, chest pain, regurgitation, and choking cough at night), and integrated relaxation pressure (eosohageal motility by high resolution manometry), and max-width of esophagus (X-ray barium esophagram) were assessed at baseline, at follow-up 6 months and 12 months. Results: Eighty-nine patients were involved from December 2014 to May 2016. There were 55 patients including 32 patients with PD and 23 patients with POEM at follow-up 6 months and 32 patients including 17 with PD and 15 patients at follow-up 12 months. Symptoms score and integrated relaxation pressure (IRP) in both with PD and with POEM improved significantly at followup 6 months and 12 months compared with at baseline (P<0.05), while there was no significant change in width of esophagus (table 1 and 2).There was no significant difference in difference value of symptoms score, IRP, and width of esophagus between with PD and with POEM at follow-up 6 months(17(12,20.8)vs16(11,20), 11.6(3.3,18.8)mmHg vs15.8(3.8,26.8)mmHg, and 0(-1.5,0.8)cm vs0.6(-0.7,2) cm, respectively, P>0.05) and 12 months(15(10.5,17.3)vs13.5(9,18.0), 14.7(6.2,20)mmHg vs14.7(8.1,24) mmHg , and 0.2(1.0,1)cm vs0.6(-1.2,1.5)cm, respectively, P >0.05).Conclusion: Both PD and POEM could improve symptoms and IRP in patients with achalasia, while no impact on width of esophagus. No significant difference in outcome between with PD and with POEM suggested that two minimally invasive methods under endoscopy have therapeutic equivalence in patients with achalasia. Table 1.Outcome of PD therapy at follow-up 6 months and 12months (M(Q1,Q3))
Mo1497 TIME BARIUM ESOPHAGRAM ASSISTS WITH THERAPY SELECTION IN PATIENTS WITH ESOPHAGO-GASTRIC OUTFLOW OBSTRUCTION Steven Clayton, Claire Shin, Nirav Patil, Joel E. Richter Background: Treatment of patients with EGJOO patients remains unclear. Timed barium esophagram (TBE) accurately and reproducibly evaluates esophageal emptying and may assist therapy selection in patients with EGJOO. Our aims were to identify patients with the diagnosis of EGJOO on high-resolution manometry (HRM) and investigate the clinical response and patient satisfaction in EGJOO patients after assigning therapy based on esophageal emptying on TBE to either treatment with pneumatic dilation (PD) versus bougie dilation (BD). Methods: Multicenter study examining consecutive HRMs to identify patients with EGJOO, defined as a mean integrated relaxation pressure (IRP) ≥15 mmHg with intact peristalsis. Our practice is patient's with evidence of poor esophageal emptying on TBE receive PD and patient's with normal esophageal emptying undergo large diameter BD. HRM, TBE, endoscopic reports, and previous treatments were analyzed in detail. Patients with EGJOO after undergoing treatment were contacted by telephone and asked about their symptom severity and symptom frequency using the Brief Esophageal Dysphagia Questionnaire* and overall treatment satisfaction (measured on a scale of 1 to 10: 1 being not pleased with current symptoms, 10 being very satisfied). Results: 25 patients with EGJOO were treated with PD (n=14) and BD (n=11). Their demographic characteristics, manometry results, TBE results and patient outcomes are described in Table 1. PD was performed on all patients with a 30mm Rigiflex (Microvasive, Boston Scientific Corporation, Boston. MA,
AGA Abstracts
IRP: integrated relaxation pressure. IPR is the same as below.
S-696
Table 2.Outcome of POEM therapy at follow-up 6 months and 12months (M(Q1,Q3))
Mo1500
Objective To understand the effect of trimebutine maleate in the treatment with elderly patients with reflux esophagitis Methods The 160 cases of elderly patients with diagnosis of reflux esophagitis by gastroscope esophageal motility manometry and 24h esophageal pH impedance monitoring acid reflux with gastroesophageal disease,at same time with typical reflux symptoms, were randomly divided into four groups and were treated with proton pump inhibitor (PPI )esomeprazole 20mg, bid, AC for 8 weeks. Meanwhile, group A was treated with itopride hydrochloride 50mg, tid, AC; group B with citrate mosapride 5mg, tid, AC; group C trimebutine maleate 200mg, tid, AC; group D as control group; After therapy of 4th and 8th weeks, respectively , symptoms improving were observed; In the 8th weeks, the 160 cases were performed with endoscopy, esophageal motility manometry, 24h esophageal pH impedance monitoring . Results 1.Clinical efficacy evaluation: after 8 weeks treatment, in group A the total effective rate was 97.5%, group B 95%, group C 92.5% and group D 77.5% , and the effect was more obvious in 8th weeks. 2. Endoscopic examination showed that the cure rate in group A was 70% and effective rate was 87.5%, B group was 62.5%, 92.5%, C group 72.5%, 87.5%, D group 67.5%, 85.0%. 3. Esophageal motility manometry : after 8 weeks'treatment, LESP, LESR, LEPP and esophageal body abnormal contraction percentage were improved than before treatment in 4 groups , A, B two groups were obviously more, the group C in LEPP had no change.4. 24h pH- impedance monitoring: There are a number of improvements in the following areas compared with before treatment: pH < 4 total time percentage, pH < 4 standing time percentage, the percentage of pH < 4 supine, supine reflux times, supine reflux, 5min times, supine longest reflux time (min),also the observation group was significantly more improved than the control group ; Being compared with before treatment, the number of acid reflux significantly reduced in 4 groups, the number of non acid reflux reduced significantly; the number of reflux liquid, mixed reflux in 4 groups had improved being compared with before treatment, the number of gas reflux in observed groups were also had same improving, especially in A and B group; In the number of proximal reflux episodes, the observation group decreased significantly than the D group after therapy.Conclusions Prokinetic drugs combined with PPI therapy in elderly patients with RE in improving the clinical symptoms, the digestive tract dynamic are better than that of single application of PPI. Trimebutine maleate, that may play a role through Selectively improve esophageal motility, lower esophageal sphincter pressure and gastric emptying function , could benefit to improve esophageal motility similar with mosapride citrate and itopride hydrochloride. It is safe to use in the elderly.
Mo1499 RETAINED ESOPHAGEAL CONTRAST ON MODIFIED BARIUM SWALLOW STUDY PREDICTS ABNORMAL HIGH RESOLUTION ESOPHAGEAL MANOMETRY David Lin, Jeremy Wang, Andrew A. Erman, Dinesh Chhetri, Conklin Jeffrey Introduction: Modified barium swallow studies (MBSS) are performed to evaluate oropharyngeal dysphagia. In our institution, in addition to the standard exam, a brief fluoroscopic assessment of retained esophageal contrast is performed. A positive finding might indicate an underlying esophageal motility disorder necessitating high-resolution esophageal manometry (HREM) evaluation. Retained contrast assessment during MBSS might be an effective screening tool for esophageal dysmotility. Objectives: To determine whether retained esophageal contrast on MBSS is associated with an abnormal HREM. Methods: We performed a retrospective study of consecutive patients with retained esophageal contrast on MBSS between July 2013 and July 2016. All patients were referred for MBSS to evaluate what was clinically felt to be pharyngeal dysphagia. If no pharyngeal cause for dysphagia was identified, the speech pathologist obtained a fluoroscopic image of the esophagus two minutes after the last radiographically evaluated swallow. All patients with retained esophageal contrast were routinely referred for gastroenterology evaluation for HREM evaluation. For these patients, we analyzed available manometry studies and classified motility abnormalities using the Chicago Classification v3.0. Results: We identified 35 patients who had retained esophageal contrast on MBSS and gastroenterology evaluation. Thirty-one (89%) patients underwent HREM. Of patients with HREM, 25 (81%) had abnormal findings, 23 (74%) of which were classifiable based on the Chicago Classification v3.0 scheme. Under the Chicago Classification, 8 (26%) had ineffective esophageal motility, 5 (16%) had achalasia, 4 (13%) had absent contractility, 3 (10%) had esophagogastric junction outlet obstruction, and 3 (10%) had Jackhammer esophagus. The remaining two patients with non-classifiable abnormalities included hypotensive lower esophageal sphincter (LES) and failed peristalsis of the striated muscle. Conclusion: The majority of patients with retained esophageal contrast on MBSS had abnormal HREM studies. Assessment of retained esophageal contrast should be added to the MBSS evaluation as it is likely to indicate an underlying esophageal motility disorder.
Figure 1. Abnormalities on high resolution esophageal manometry in patients with retained esophageal contrast.
Mo1501 INVESTIGATION OF SHORT-TERM EFFICACY OF N-ACETYLCYSTEINE FOR ACHALASIA Bin Wang, Wei Zhao, Lili Zhang, Hong Jin, Qiuyu Chen, Bangmao Wang Backgrounds&Aims: Achalasia is a primary esophageal motility disorder which has not yet been fully elucidated. It is mainly characterized by lack of peristalsis and a lower esophageal sphincter that fails to relax appropriately in response to swallowing. Therapies for Achalasia include medication (mainly calcium antagonists), balloon dilatation, Heller myotomy and POEM, however, the long-term efficacy of these therapies are not wholly known.In addition, current medication such as calcium antagonists is considered to be unsatisfactory even during short-term therapy for side effects.It has been reported that H2S synthesis enzymes exist in human esophagus and the expression of the two key H2S synthesis enzymes (CBS and CSE) reduce in LES of achalasia patients. The aim of this study was to evaluate Nacetylcysteine (NAC, doner of H2S synthesis enzymes) in the treatment of Achalasia. Methods: 10 patients of Achalasia without other organic diseases were recruited from January to December 2016 in Department of Gastroenterology, General Hospital of Tianjin Medical University. The diagnosis was comfirmed by clinical manifestation, esophagoscopy, barium esophagram, and high-resolution esophageal manometry(HRM). None of them had been treated with Heller myotomy, balloon dilatation, POEM or Botulinum toxin injection before. After informed consents signed, all the patients were asked to cease other medication for at least 1 week, and given NAC (Flumucil effervescent tablet, 200mg tid, Hainan Zambon
Figure 2. High resolution esophageal manometry Chicago Classification v3.0 in patients with retained esophageal contrast on MBSS. IEM, ineffective esophageal motility; Ach, Achalasia; AC, absent contractility; EGJOO, esophogastric junction outlet obstruction; JH, jackhammer esophagus.
S-697
AGA Abstracts
AGA Abstracts
THE ROLE OF TRIMEBUTINE IN THE TREATMENT OF ELDERLY PATIENTS WITH REFLEX ESOPHAGITIS Wei Wang
USA) achalasia balloon dilator. Two patients required a second dilation with 35 mm balloon for symptomatic relief. In the PD group, overall satisfaction score was 7.9 with a 10-month average follow up. In the bougie group, (average number of bougie treatments 1.8) overall satisfaction score was 7.7 with an 8-month average follow up. In the PD group, total score for symptom frequency and severity assessed via the Brief Esophageal Dysphagia Questionnaire was 8.14, whereas the total score of the BD group was 8.5. Conclusion: TBE can be a useful tool in determining which patients would benefit from PD versus BD. Similar to achalasia, patients with a standing barium column should undergo PD as first line therapy. However in patients with normal liquid emptying on TBE, BD is a reasonable first therapy. Using this selection criteria, there is no significant difference in dysphagia severity (p=0.91) or overall satisfaction (p=0.87) in EGJOO patients undergoing treatment with pneumatic dilation versus bougie dilation. Reference * Taft, T. H., Riehl, M., Sodikoff, J. B., Kahrilas, P. J., Keefer, L., Doerfler, B. and Pandolfino, J. E. (2016), Development and validation of the brief esophageal dysphagia questionnaire. Neurogastroenterol. Motil.. doi:10.1111/ nmo.12889
AGA Abstracts
IDENTIFICATION OF HIATUS HERNIA BY HIGH RESOLUTION MANOMETRY AND ENDOSCOPY IN PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE Antoni Stadnicki, Józef Kurek, Ewa Klimacka-Nawrot, Malgorzata Bozek, Katarzyna Bilnik Background. Current data related to accuracy in diagnosing of hiatus hernia by high resolution manometry (HRM) and upper endoscopy is equivocal. This study was aimed to compare the value of HRM and endoscopy in detecting sliding hiatus hernia in patients with gastroesophageal reflux disease. Material and Methods. Sensitivity and specificity of HRM and endoscopy were assessed in 31 patients (20 females; mean age 48.2) who were qualified for Nissen fundoplication. Intraoperative diagnosis of hiatus hernia was the gold standard. Manometric protocol included 10 consecutive swallows of 10 ml of water. Manometrically data analysis was done with esophageal pressure topography according to the Chicago Classification. Results. Twenty nine patients out of 31 were found to have sliding hiatus hernia during surgery. Fourteen patients had manometric criteria for hiatus hernia, while 19 patients were found to have hiatus hernia by upper endoscopy before surgery. In HRM there were no false positive results, although 15 false negative results were shown, thus specificity and sensitivity of HRM in detecting hiatus hernia were 100% and 48% respectively. In endoscopy false positive data was observed in one patients, whereas false negative results were found in 10 patients indicating specificity 50% and sensitivity 66 % of endoscopy for identification of hiatus hernia. False negative results (sensitivity) not significantly different as compared HMR and endoscopy (52% vs. 34% respectively, p= 0.29). In addition, no significant discordance (using McNemar's test) was found between two methods (p=0.58). Conclusions. Due to poor sensitivity both high resolution manometry and upper endoscopy are not reliable tools to diagnose sliding hiatus hernia in patients with gastroesophageal reflux. However, high resolution manometry has a good specificity and ability to rule out sliding hiatus hernia.
Mo1496 CHANGE IN THE INTERSTITIAL CELLS OF CAJAL AND NNOS POSITIVE NEURONAL CELLS WITH AGING IN THE ESOPHAGUS OF F344 RATS Nayoung Kim, Hee Jin Kim, Dong Ho Lee
Mo1498
Background and Aims: Previous human and animal studies suggested that the esophageal motility function deteriorates in the elderly. However, the aging-associated structural and molecular changes in esophagus have not yet been established. The aim of this study was to evaluate the changes of morphology, interstitial cell of Cajal (ICC) and neuronal nitric oxide synthase (nNOS)-positive neuronal cell in the esophagus of F344 rat at different ages (6-, 31-, 74-wk and 2-yr). Methods: The esophagus of Fischer 344 rats at four different ages (6, 31, 74 weeks, and 2 years) was studied (each, n = 6-10). The area of lamina propria and endomysium (a connective tissue surrounding each muscle cells) was calculated as a percentage of the total mucosa and muscle area. The immunoreactivity of c-Kit, nNOS and protein gene product 9.5 (PGP 9.5, general neuronal marker) was counted after immunohistochemistry. Expression of c-kit, stem cell factor (SCF, a ligand of c-Kit), PGP 9.5 and nNOS mRNA was also measured by reverse transcriptase-polymerase chain reaction, and expression of c-kit and nNOS protein was detected by Western blot analysis. Results: The lamina propria area was increased significantly in 2-year-old rats compared with 6-week-old rats (P=0.005). The endomysium area of longitudinal muscle markedly decreased with aging (6 week vs 2 year, P <0.001), while endomysium areas of circular muscle did not significantly decrease (6 week vs 2 year, P=0.135). The densities of c-kit-immunoreactive ICCs and nNOSimmunoreactive neuronal cells were significantly decreased in 2-year-old rats compared with 6-week-old rats (both P <0.05), but there was no significant change of the density of PGP 9.5-immunopositive cells with aging (6 week vs 2 year, P=0.754). The expressions of c-kit, SCF and nNOS mRNA were significantly decreased in 2- year-old rats compared with 6week-old rats (c-kit, P=0.002; SCF, P=0.012; nNOS, P=0.009), while the decrease of PGP 9.5 mRNA expression was not significant with aging (6 week vs 2 year, P=0.123). Western blot analysis showed significant decrease of nNOS expression in 2- year-old rats compared with 6-week-rats (P=0.008), but the decrease of c-Kit protein expression was not significant (6 week vs 2 year, P=0.247). Conclusions: The increase of lamina propria area and the decrease of endomysium, c-kit, SCF and NOS expression with relatively preserved total enteric nervous system in rat esophagus may explain the aging-associated esophageal dysmotility.
SHORT-TERM OUTCOME OF PER ORAL ENDOSCOPIC MYOTOMY VERSUS ENDOSCOPIC PNEUMATIC DILATION Xiaohong Sun, Zhifeng Wang, Qingwei Jiang, Xi Wu, Tao Guo, Fang Yao, Meiyun Ke Background and aim:Achalasia is the most common primary motility disorder of esophagus and characterized by impaired deglutitive relaxation of the lower esophageal sphincter due to loss of inhibitory neurons ofmyenteric plexus. The aim of this study is to compare outcome of per oral endoscopic myotomy (POEM) and pneumatic dilation (PD) for patients with achalasia. Methods:This prospective study is involved untreated patient with achalasia aged 18 years-old and moreand unlimited genderin sequence. At first, doctors introduced the two therapies of POEM and PDfor patients in detail and then the patients would choose either POEM or PD by themselves. The symptoms(including dysphagia, chest pain, regurgitation, and choking cough at night), and integrated relaxation pressure (eosohageal motility by high resolution manometry), and max-width of esophagus (X-ray barium esophagram) were assessed at baseline, at follow-up 6 months and 12 months. Results: Eighty-nine patients were involved from December 2014 to May 2016. There were 55 patients including 32 patients with PD and 23 patients with POEM at follow-up 6 months and 32 patients including 17 with PD and 15 patients at follow-up 12 months. Symptoms score and integrated relaxation pressure (IRP) in both with PD and with POEM improved significantly at followup 6 months and 12 months compared with at baseline (P<0.05), while there was no significant change in width of esophagus (table 1 and 2).There was no significant difference in difference value of symptoms score, IRP, and width of esophagus between with PD and with POEM at follow-up 6 months(17(12,20.8)vs16(11,20), 11.6(3.3,18.8)mmHg vs15.8(3.8,26.8)mmHg, and 0(-1.5,0.8)cm vs0.6(-0.7,2) cm, respectively, P>0.05) and 12 months(15(10.5,17.3)vs13.5(9,18.0), 14.7(6.2,20)mmHg vs14.7(8.1,24) mmHg , and 0.2(1.0,1)cm vs0.6(-1.2,1.5)cm, respectively, P >0.05).Conclusion: Both PD and POEM could improve symptoms and IRP in patients with achalasia, while no impact on width of esophagus. No significant difference in outcome between with PD and with POEM suggested that two minimally invasive methods under endoscopy have therapeutic equivalence in patients with achalasia. Table 1.Outcome of PD therapy at follow-up 6 months and 12months (M(Q1,Q3))
Mo1497 TIME BARIUM ESOPHAGRAM ASSISTS WITH THERAPY SELECTION IN PATIENTS WITH ESOPHAGO-GASTRIC OUTFLOW OBSTRUCTION Steven Clayton, Claire Shin, Nirav Patil, Joel E. Richter Background: Treatment of patients with EGJOO patients remains unclear. Timed barium esophagram (TBE) accurately and reproducibly evaluates esophageal emptying and may assist therapy selection in patients with EGJOO. Our aims were to identify patients with the diagnosis of EGJOO on high-resolution manometry (HRM) and investigate the clinical response and patient satisfaction in EGJOO patients after assigning therapy based on esophageal emptying on TBE to either treatment with pneumatic dilation (PD) versus bougie dilation (BD). Methods: Multicenter study examining consecutive HRMs to identify patients with EGJOO, defined as a mean integrated relaxation pressure (IRP) ≥15 mmHg with intact peristalsis. Our practice is patient's with evidence of poor esophageal emptying on TBE receive PD and patient's with normal esophageal emptying undergo large diameter BD. HRM, TBE, endoscopic reports, and previous treatments were analyzed in detail. Patients with EGJOO after undergoing treatment were contacted by telephone and asked about their symptom severity and symptom frequency using the Brief Esophageal Dysphagia Questionnaire* and overall treatment satisfaction (measured on a scale of 1 to 10: 1 being not pleased with current symptoms, 10 being very satisfied). Results: 25 patients with EGJOO were treated with PD (n=14) and BD (n=11). Their demographic characteristics, manometry results, TBE results and patient outcomes are described in Table 1. PD was performed on all patients with a 30mm Rigiflex (Microvasive, Boston Scientific Corporation, Boston. MA,
AGA Abstracts
IRP: integrated relaxation pressure. IPR is the same as below.
S-696
Table 2.Outcome of POEM therapy at follow-up 6 months and 12months (M(Q1,Q3))
Mo1500
Objective To understand the effect of trimebutine maleate in the treatment with elderly patients with reflux esophagitis Methods The 160 cases of elderly patients with diagnosis of reflux esophagitis by gastroscope esophageal motility manometry and 24h esophageal pH impedance monitoring acid reflux with gastroesophageal disease,at same time with typical reflux symptoms, were randomly divided into four groups and were treated with proton pump inhibitor (PPI )esomeprazole 20mg, bid, AC for 8 weeks. Meanwhile, group A was treated with itopride hydrochloride 50mg, tid, AC; group B with citrate mosapride 5mg, tid, AC; group C trimebutine maleate 200mg, tid, AC; group D as control group; After therapy of 4th and 8th weeks, respectively , symptoms improving were observed; In the 8th weeks, the 160 cases were performed with endoscopy, esophageal motility manometry, 24h esophageal pH impedance monitoring . Results 1.Clinical efficacy evaluation: after 8 weeks treatment, in group A the total effective rate was 97.5%, group B 95%, group C 92.5% and group D 77.5% , and the effect was more obvious in 8th weeks. 2. Endoscopic examination showed that the cure rate in group A was 70% and effective rate was 87.5%, B group was 62.5%, 92.5%, C group 72.5%, 87.5%, D group 67.5%, 85.0%. 3. Esophageal motility manometry : after 8 weeks'treatment, LESP, LESR, LEPP and esophageal body abnormal contraction percentage were improved than before treatment in 4 groups , A, B two groups were obviously more, the group C in LEPP had no change.4. 24h pH- impedance monitoring: There are a number of improvements in the following areas compared with before treatment: pH < 4 total time percentage, pH < 4 standing time percentage, the percentage of pH < 4 supine, supine reflux times, supine reflux, 5min times, supine longest reflux time (min),also the observation group was significantly more improved than the control group ; Being compared with before treatment, the number of acid reflux significantly reduced in 4 groups, the number of non acid reflux reduced significantly; the number of reflux liquid, mixed reflux in 4 groups had improved being compared with before treatment, the number of gas reflux in observed groups were also had same improving, especially in A and B group; In the number of proximal reflux episodes, the observation group decreased significantly than the D group after therapy.Conclusions Prokinetic drugs combined with PPI therapy in elderly patients with RE in improving the clinical symptoms, the digestive tract dynamic are better than that of single application of PPI. Trimebutine maleate, that may play a role through Selectively improve esophageal motility, lower esophageal sphincter pressure and gastric emptying function , could benefit to improve esophageal motility similar with mosapride citrate and itopride hydrochloride. It is safe to use in the elderly.
Mo1499 RETAINED ESOPHAGEAL CONTRAST ON MODIFIED BARIUM SWALLOW STUDY PREDICTS ABNORMAL HIGH RESOLUTION ESOPHAGEAL MANOMETRY David Lin, Jeremy Wang, Andrew A. Erman, Dinesh Chhetri, Conklin Jeffrey Introduction: Modified barium swallow studies (MBSS) are performed to evaluate oropharyngeal dysphagia. In our institution, in addition to the standard exam, a brief fluoroscopic assessment of retained esophageal contrast is performed. A positive finding might indicate an underlying esophageal motility disorder necessitating high-resolution esophageal manometry (HREM) evaluation. Retained contrast assessment during MBSS might be an effective screening tool for esophageal dysmotility. Objectives: To determine whether retained esophageal contrast on MBSS is associated with an abnormal HREM. Methods: We performed a retrospective study of consecutive patients with retained esophageal contrast on MBSS between July 2013 and July 2016. All patients were referred for MBSS to evaluate what was clinically felt to be pharyngeal dysphagia. If no pharyngeal cause for dysphagia was identified, the speech pathologist obtained a fluoroscopic image of the esophagus two minutes after the last radiographically evaluated swallow. All patients with retained esophageal contrast were routinely referred for gastroenterology evaluation for HREM evaluation. For these patients, we analyzed available manometry studies and classified motility abnormalities using the Chicago Classification v3.0. Results: We identified 35 patients who had retained esophageal contrast on MBSS and gastroenterology evaluation. Thirty-one (89%) patients underwent HREM. Of patients with HREM, 25 (81%) had abnormal findings, 23 (74%) of which were classifiable based on the Chicago Classification v3.0 scheme. Under the Chicago Classification, 8 (26%) had ineffective esophageal motility, 5 (16%) had achalasia, 4 (13%) had absent contractility, 3 (10%) had esophagogastric junction outlet obstruction, and 3 (10%) had Jackhammer esophagus. The remaining two patients with non-classifiable abnormalities included hypotensive lower esophageal sphincter (LES) and failed peristalsis of the striated muscle. Conclusion: The majority of patients with retained esophageal contrast on MBSS had abnormal HREM studies. Assessment of retained esophageal contrast should be added to the MBSS evaluation as it is likely to indicate an underlying esophageal motility disorder.
Figure 1. Abnormalities on high resolution esophageal manometry in patients with retained esophageal contrast.
Mo1501 INVESTIGATION OF SHORT-TERM EFFICACY OF N-ACETYLCYSTEINE FOR ACHALASIA Bin Wang, Wei Zhao, Lili Zhang, Hong Jin, Qiuyu Chen, Bangmao Wang Backgrounds&Aims: Achalasia is a primary esophageal motility disorder which has not yet been fully elucidated. It is mainly characterized by lack of peristalsis and a lower esophageal sphincter that fails to relax appropriately in response to swallowing. Therapies for Achalasia include medication (mainly calcium antagonists), balloon dilatation, Heller myotomy and POEM, however, the long-term efficacy of these therapies are not wholly known.In addition, current medication such as calcium antagonists is considered to be unsatisfactory even during short-term therapy for side effects.It has been reported that H2S synthesis enzymes exist in human esophagus and the expression of the two key H2S synthesis enzymes (CBS and CSE) reduce in LES of achalasia patients. The aim of this study was to evaluate Nacetylcysteine (NAC, doner of H2S synthesis enzymes) in the treatment of Achalasia. Methods: 10 patients of Achalasia without other organic diseases were recruited from January to December 2016 in Department of Gastroenterology, General Hospital of Tianjin Medical University. The diagnosis was comfirmed by clinical manifestation, esophagoscopy, barium esophagram, and high-resolution esophageal manometry(HRM). None of them had been treated with Heller myotomy, balloon dilatation, POEM or Botulinum toxin injection before. After informed consents signed, all the patients were asked to cease other medication for at least 1 week, and given NAC (Flumucil effervescent tablet, 200mg tid, Hainan Zambon
Figure 2. High resolution esophageal manometry Chicago Classification v3.0 in patients with retained esophageal contrast on MBSS. IEM, ineffective esophageal motility; Ach, Achalasia; AC, absent contractility; EGJOO, esophogastric junction outlet obstruction; JH, jackhammer esophagus.
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AGA Abstracts
AGA Abstracts
THE ROLE OF TRIMEBUTINE IN THE TREATMENT OF ELDERLY PATIENTS WITH REFLEX ESOPHAGITIS Wei Wang