Esophagogastric junction compliance on impedance planimetry (EndoFLIP™) following peroral endoscopic myotomy (POEM) predicts improvement in postoperative eckardt score

Amundson, Julia R.; Wu, Hoover; VanDruff, Vanessa N.; Campbell, Michelle; Kuchta, Kristine; Hedberg, Herbert M.; Ujiki, Michael

doi:10.1007/s00464-022-09432-2

Cited by 9 publications

(8 citation statements)

References 12 publications

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“…Although FLIP measurements performed with 40 ml fill volume are considered most reliable [ 7 ], FLIP distention protocols vary across studies. In relevant studies, Ngamruenphong et al [ 5 ] registered FLIP measurements at 30 ml fill volume, Amundson et al [ 19 ] changed the FLIP protocol during their study from 30 to 40 ml fill volume, and Holmstrom et al [ 4 ] used 40 ml fill volume. Also, the reported FLIP variable differed from single-plane CSA [ 5 ] and DI [ 4 ] measurements to volume-based compliance evaluation [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…In relevant studies, Ngamruenphong et al [ 5 ] registered FLIP measurements at 30 ml fill volume, Amundson et al [ 19 ] changed the FLIP protocol during their study from 30 to 40 ml fill volume, and Holmstrom et al [ 4 ] used 40 ml fill volume. Also, the reported FLIP variable differed from single-plane CSA [ 5 ] and DI [ 4 ] measurements to volume-based compliance evaluation [ 19 ]. These studies were all retrospective and did not include a follow-up FLIP examination.…”

Section: Discussionmentioning

confidence: 99%

“…These studies were all retrospective and did not include a follow-up FLIP examination. Moreover, two of the studies [ 5 , 19 ] did not include a control group without intraoperative FLIP examination.…”

Section: Discussionmentioning

confidence: 99%

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Intraoperative distensibility measurement in POEM for achalasia: impact on patient outcome and associations with other outcome variables at 1-year follow-up

Evensen,

Sandstad,

Larssen

et al. 2023

Surg Endosc

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Background and aims The functional luminal imaging probe (FLIP) can provide measurements of lower esophageal sphincter (LES) distensibility. Studies report that use of intraoperative FLIP examination during peroral endoscopic myotomy (POEM) for achalasia is associated with treatment success, but evidence is limited and inconsistent. The main aim of the present study was to assess associations between intraoperative FLIP values and 1-year outcomes. Additionally, associations between 1-year FLIP measurements and other 1-year outcome variables were studied. Methods We performed a single-center prospective study of consecutive achalasia patients treated with POEM with a standardized 1-year follow-up. The inclusion period was from June 2017 to January 2020. We compared 1-year outcomes (FLIP measurement values, Eckardt score (ES), reflux esophagitis, timed barium esophagogram (TBE), and lower esophageal sphincter resting pressure (LES-rp)) in patients with and without intraoperative FLIP examination. We also assessed associations between intraoperative FLIP values, 1-year FLIP values, and other 1-year outcomes. Results are given as median (IQR), and non-parametrical statistical analyses were applied. Results Sixty-two patients (27 females) with median age 45 years (35–54) were included. Baseline characteristics were similar in patients with (n = 32) and without (n = 30) intraoperative FLIP examination. In patients with intraoperative FLIP, ES was 2 (1–3) and LES distensibility index (DI) 3.7 (2.6–5.4) after 1 year, compared with ES 2 (1–3) and DI 4.0 (3.1–6.8)) in patients without intraoperative FLIP (ns). Intraoperative DI was not correlated with 1-year ES or DI. One-year DI correlated significantly with 1-year ES (rs − 0.42), TBE (rs − 0.34), and LES-rp (rs − 0.29). Conclusions Use of intraoperative FLIP measurements in POEM for achalasia is not associated with improved 1-year outcome, and the clinical value of intraoperative FLIP in POEM for achalasia is questioned. Follow-up FLIP measurements are moderately associated with symptomatic outcome, and may serve as an additional diagnostic modality in post-treatment evaluation. Graphical abstract

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Intraoperative distensibility measurement in POEM for achalasia: impact on patient outcome and associations with other outcome variables at 1-year follow-up

Evensen,

Sandstad,

Larssen

et al. 2023

Surg Endosc

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“…More than one thousand institutions worldwide were engaged in the study of POEM in treating achalasia. Among them, the top ten by the number of publications were Showa Univer-sity (69), Northwestern University (44), Asian Institute of Gastroenterology (37), Fudan University (33), University of Chicago (25), Kobe University Hospital (22), Johns Hopkins Medical Institution (21), Niigata University (20), Fukuoka University (20), and Oregon Clinic (20) (Figure 4A). In the top 10 institutions, Japan and the USA each had four organizations, while India and China each had one organization.…”

Section: Institution Analysismentioning

confidence: 99%

A bibliometric analysis of peroral endoscopic myotomy for achalasia: Where have we been and where should we go next?

Zhang

2023

Japanese J Gastroenterol Res

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“…The use of intraoperative DI and cross-sectional area evaluations allowed optimization of the myotomy extent. While EndoFLIP has been used in standard esophageal POEM 3 , its potential utility may be particularly pronounced in more challenging cases.…”

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confidence: 99%

Impedance planimetry-guided peroral endoscopic myotomy of the fundoplication valve

Nagl,

Ebigbo,

Barthet

et al. 2024

Endoscopy

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Esophagogastric junction compliance on impedance planimetry (EndoFLIP™) following peroral endoscopic myotomy (POEM) predicts improvement in postoperative eckardt score

Cited by 9 publications

References 12 publications

Intraoperative distensibility measurement in POEM for achalasia: impact on patient outcome and associations with other outcome variables at 1-year follow-up

Intraoperative distensibility measurement in POEM for achalasia: impact on patient outcome and associations with other outcome variables at 1-year follow-up

A bibliometric analysis of peroral endoscopic myotomy for achalasia: Where have we been and where should we go next?

Impedance planimetry-guided peroral endoscopic myotomy of the fundoplication valve

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