High-Resolution Manometry in Treated Achalasia: Scoping Review and Novel Nomenclature

Area of Science:

• Gastroenterology
• Esophageal Physiology
• Diagnostic Manometry

Background:

• The Chicago Classification (CC) for high-resolution manometry (HRM) is standard for primary esophageal motility disorders.
• CC lacks guidance for HRM interpretation in achalasia patients post-treatment (surgery or endoscopic interventions).

Purpose of the Study:

• To provide expert recommendations for HRM interpretation in treated achalasia.
• To propose novel nomenclature and a management flowchart to address diagnostic gaps in CC for treated achalasia.

Main Methods:

• Systematic literature review of 3 major databases (PubMed/MEDLINE, Embase, Web of Science) up to December 2024.
• Development of recommendations by a panel of 12 esophageal motility experts.
• Proposal of new terminology and a management flowchart.

Main Results:

• 40 articles on HRM in treated achalasia were identified.
• Proposed terms: Treated Achalasia with Outflow Obstruction (TAOO) for unsuccessful treatment and Adequately Treated Achalasia (ATA) for successful treatment.
• Defined criteria for incomplete relaxation (IRP), obstructive features (intrabolus pressurization, RDC), and body contractility (ineffective/spastic). HRM with impedance aids esophageal emptying assessment.

Conclusions:

• This review provides crucial guidance for HRM interpretation in treated achalasia.
• Novel descriptive terms are introduced to better reflect pathophysiology post-treatment.
• Conventional CC is unsuitable for describing treated achalasia.