AUTHOR=Olvera-Prado Héctor , Peralta-Figueroa José , Narváez-Chávez Sofía , Rendón-Macías Mario E. , Perez-Ortiz Andric , Furuzawa-Carballeda Janette , Méndez-Flores Silvia , Núñez-Pompa María del Carmen , Trigos-Díaz Alonso , Areán-Sanz Rodrigo , López-Verdugo Fidel , Coss-Adame Enrique , Valdovinos Miguel A. , Torres-Villalobos Gonzalo 

TITLE=Predictive factors associated with the persistence of chest pain in post-laparoscopic myotomy and fundoplication in patients with achalasia

JOURNAL=Frontiers in Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.941581

DOI=10.3389/fmed.2022.941581

ISSN=2296-858X

ABSTRACT=Background: Episodic angina-like retrosternal pain is a prevalent symptom for achalasia patients pre- and post-treatment. The cause of postoperative chest pain remains poorly understood. Moreover, there are no reports on their predictive value for chest pain in the long-term post-treatment. The effect of laparoscopic myotomy (LHM) and fundoplication techniques (Dor vs. Toupet) is unclear.
Methods: We analyzed a cohort of 118 achalasia cases treated with LHM and randomly assigned fundoplication technique. All patients were diagnosed with achalasia by high-resolution manometry (HRM). Patients were followed up at one-, six-, 12-, 24-, and 48-months post-treatment. We implemented unadjusted and adjusted logistic regression analyses to evaluate the predictive significance of pre- and postoperative clinical factors.
Results: Preoperative chest pain with every meal was associated with an increased risk of occasional postoperative chest pain (unadjusted model:  OR = 12, 95% CI: 2.2–63.9, P = 0.006; adjusted model: OR = 26, 95% CI: 2.6–259.1, P = 0.005). In type II achalasia, hypercontraction was also associated with an increased risk of chest pain (unadjusted model:  OR = 2.6 e9 in all patients). There were no significant differences associated with age, type of achalasia, dysphagia, esophageal shape, and IRP with an increased risk of occasional postoperative chest pain. Also, there was no significant difference between fundoplication techniques or surgical approaches (e.g., length of myotomy).
Conclusions: Preoperative chest pain with every meal was associated with a higher risk of occasionally postoperative chest pain.