A Comparison of the High Resolution Manometry Systems Manoscan and Starlet (a New System With Unisensor Catheter)

HRM system with impedance monitoring, USA) between 2009 and 2013 in our university hospital with dysphagia and/or chest pain after excluding upper GI organic diseases by endoscopy.Forty-eight newly diagnosed achalasia patients were enrolled in the study.The patients were categorized into 3 subtypes according to the Chicago classification (CC): Type I, no esophageal pressurization in 8 of 10 swallows; type II, pan-esophageal compression >30 mmHg; and type III, with spasm.Pneumatic balloon dilatation has been performed using the Rigiflex balloon dilator of 30-, 35-, or 40-mm 1-3 times over a few-days-interval.Non-responder (NR) was defined as a patient who needed further treatment immediately after the first treatment.Relapse was defined as a patient whose symptoms worsened after the symptoms had been reduced.The outcome after treatment was compared among the subtypes of the CC.Results: The enrolled patients were classified into type I (n=18), II (n= 26), and III (n=4), respectively.Pneumatic dilatation was performed on 21 patients (type I: 13 patients, type II: 7 patients, type III: 1 patient) for the first treatment.Along the mean follow-up of 24.9 months, NR was observed in only one patient (type III), whereas 3 patients out of 21 patients relapsed after the pneumatic balloon dilatation.In these patients, the symptom got worse after 30.5, 34.3, and 2.5-month.These three patients did not have any characteristic feature in age, sex, or LES pressure, but these were all type I of the CC.None of the type II and type III patients with pneumatic balloon dilatation relapsed.Laparoscopic Heller myotomy with fundoplication was performed for the first treatment on 13 patients (type I: 4 patients, type II: 7 patients, type III: 2 patients).After the surgery, neither NR nor relapse occurred after laparoscopic surgery.Conclusion: Only the type I patients relapsed after the pneumatic balloon dilatation.The long term outcome was different among the subtypes of the CC, which allows us to choose the appropriate strategy for achalasia.