Effect of peroral endoscopic myotomy on esophagogastric junction physiology in patients with achalasia

Verlaan, Tessa; Rohof, Wout O.; Bredenoord, Albert J.; Eberl, Susanne; Rösch, Thomas; Fockens, Paul

doi:10.1016/j.gie.2013.01.006

Cited by 108 publications

(77 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although EndoFLIP offers the possibility to acquire assessment of EGJ distensibility in a more practical method compared to barostat, we have to consider that measurement of EGJ distensibility with the EndoFLIP technique remains an invasive procedure which may be associated with discomfort in patients. 33 Finally, we have to take into account additional costs of this technique as both the mobile recording device and single-use catheters are expensive.…”

Section: Discussionmentioning

confidence: 99%

“…Six months after TIF, GERD symptoms had improved according to the reduction in GERD-HRQL scores (from 26 [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]) to 10 [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], P < 0.01). Common use of acid suppressive medication was discontinued by 67% of patients, whereas 19% used PPIs occasionally and common use was present in 14%.…”

Section: Patient Characteristics and Symptom Scoresmentioning

confidence: 99%

See 1 more Smart Citation

Does Measurement of Esophagogastric Junction Distensibility by EndoFLIP Predict Therapy- responsiveness to Endoluminal Fundoplication in Patients With Gastroesophageal Reflux Disease?

Smeets

Keszthelyi

Bouvy

et al. 2015

J Neurogastroenterol Motil

View full text Add to dashboard Cite

Background/Aims In patients with gastroesophageal reflux disease (GERD), an increased esophagogastric junction (EGJ) distensibility has been described. Assessment of EGJ distensibility with the endoscopic functional luminal imaging probe (EndoFLIP) technique might identify patients responsive to transoral incisionless fundoplication (TIF), whereas postoperative measurement of EGJ distensibility might provide insight into the antireflux mechanism of TIF. Therefore, we investigated the value of the EndoFLIP technique in GERD patients treated by TIF. Methods Forty-two GERD patients underwent EGJ distensibility measurement before TIF using the EndoFLIP technique. In a subgroup of 25 patients, EndoFLIP measurement was repeated both postoperative and at 6 months follow-up. Treatment outcome was assessed according to esophageal acid exposure time (AET; objective outcome) and symptom scores (clinical outcome) 6 months after TIF. Results Multiple logistic regression analysis showed that preoperative EGJ distensibility (OR, 0.16; 95% CI, 0.03–0.78; P = 0.023) and preoperative AET (OR, 0.62; 95% CI, 0.42–0.90; P = 0.013) were independent predictors for objective treatment outcome but not for clinical outcome after TIF. The best cut-off value for objective outcome was 2.3 mm 2 /mmHg for preoperative EGJ distensibility and 11% for preoperative AET. EGJ distensibility decreased direct postoperative from 2.0 (1.2–3.3) to 1.4 (1.0–2.2) mm 2 /mmHg ( P = 0.014), but increased to 2.2 (1.5–3.0) at 6 months follow-up ( P = 0.925, compared to preoperative). Conclusions Preoperative EGJ distensibility and preoperative AET were independent predictors for objective treatment outcome but not for clinical outcome after TIF. According to our data, the EndoFLIP technique has no added value either in the preoperative diagnostic work-up or in the post-procedure evaluation of endoluminal antireflux therapy.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Patient Characteristics and Symptom Scoresmentioning

confidence: 99%

Does Measurement of Esophagogastric Junction Distensibility by EndoFLIP Predict Therapy- responsiveness to Endoluminal Fundoplication in Patients With Gastroesophageal Reflux Disease?

Smeets

Keszthelyi

Bouvy

et al. 2015

J Neurogastroenterol Motil

View full text Add to dashboard Cite

show abstract

“…13,16 Currently during POEM, the effects and completeness of myotomy can be only assessed subjectively and empirically, by evaluating the appearance of myotomy at OGD and by passing the endoscope through the cardia, trying to appreciate any resistance to the transit. In order to have a complete myotomy at the level of the LOS, submucosal dissection and myotomy are usually extended for 2-3 cm beyond the cardias on the gastric wall.…”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14] However, few studies have evaluated the possible benefits of the use of EndoFLIP during POEM. 11,15,16 The aim of this prospective observational study is to report on the effects of POEM on the OGJ and LOS, as evaluated with EndoFLIP immediately after myotomy, and to compare clinical outcomes, manometry findings and gastro-oesophageal reflux disease (GORD) incidence during follow-up with the post-operative diameter of the OGJ.…”

mentioning

confidence: 99%

EndoFLIP system for the intraoperative evaluation of peroral endoscopic myotomy

et al. 2014

View full text Add to dashboard Cite

Background: Peroral endoscopic myotomy (POEM) has been recently introduced in clinical practice for the treatment of achalasia. The endoluminal functional lumen imaging probe (EndoFLIP) system) uses impedance planimetry for the realtime measurement of the diameter of the oesophago-gastric junction. Objective: The aim of this study is to prospectively evaluate the effect of POEM on the oesophago-gastric junction using EndoFLIP. Methods: All the patients who underwent POEM in a single centre between April and July 2013 were enrolled in the study. EndoFLIP was used intraoperatively, immediately before and after POEM. During follow-up patients underwent oesophagogastroduodenoscopy, oesophageal pH monitoring and manometry. Clinical outcomes were compared with the diameter of the oesophago-gastric junction after POEM. Results: In total, 23 patients (12 males, mean age 51.7 years) were enrolled, and 21 underwent POEM successfully. Preoperative mean basal lower oesophageal sphincter pressure was 42.1 mmHg (AE17.6). Before POEM, the mean oesophago-gastric junction diameter and cross-sectional area were 6.3 mm (AE1.8) and 32.9 mm 2 (AE23.1), respectively. After treatment, the mean diameter and cross-sectional area of the oesophago-gastric junction were 11.3 mm (AE1.7 SD) and 102.38 mm 2 (AE28.2 SD), respectively. No complications occurred during a mean follow-up of 5 months. Median postoperative Eckardt score was 1. Three patients (14.3%) referred heartburn. Follow-up studies revealed gastro-oesophageal reflux disease (GORD) in 57.1% of patients and oesophagitis in 33.3%. No correlations were observed between the diameter of oesophago-gastric junction after POEM and symptoms relief, GORD incidence and lower oesophageal sphincter pressure. Conclusions: The diameter of oesophago-gastric junction substantially increases after POEM. EndoFLIP is a reliable method for the intraoperative evaluation of oesophago-gastric junction diameter. However, the real usefulness of this technology after POEM remains controversial.

show abstract

“…Nystatin 500,000 IU four times per day is given for 3 days prior to surgery. Intravenous proton pump inhibitors are typically given preoperatively due to the high incidence of postoperative reflux (19). Intravenous antibiotic prophylaxis should be administered for a standard non-cardiac thoracic procedure and may include cefazolin or clindamycin (16)(17)(18)(19)(20).…”

Section: Pre-and Intraoperative Considerationsmentioning

confidence: 99%

The current state of per oral endoscopic myotomy for achalasia

Smith

Louie

2017

J. Vis. Surg.

View full text Add to dashboard Cite

Achalasia is an acquired neuromuscular disorder that has been treated using a variety of modalities throughout medical history. Recently, the technique of per oral endoscopic myotomy (POEM) was introduced to treat the disease using a truly minimally invasive, natural orifice technique that is rapidly being adopted across the world. This review outlines the development of POEM, the technique itself, and gives a comparison to other procedures, specifically laparoscopic Heller myotomy (LHM).

show abstract

Effect of peroral endoscopic myotomy on esophagogastric junction physiology in patients with achalasia

Cited by 108 publications

References 17 publications

Does Measurement of Esophagogastric Junction Distensibility by EndoFLIP Predict Therapy- responsiveness to Endoluminal Fundoplication in Patients With Gastroesophageal Reflux Disease?

Does Measurement of Esophagogastric Junction Distensibility by EndoFLIP Predict Therapy- responsiveness to Endoluminal Fundoplication in Patients With Gastroesophageal Reflux Disease?

EndoFLIP system for the intraoperative evaluation of peroral endoscopic myotomy

The current state of per oral endoscopic myotomy for achalasia

Contact Info

Product

Resources

About