Hydraulic dilation with a shape-measuring balloon in idiopathic achalasia: a feasibility study

Kappelle, Wouter; Bogte, Auke; Siersema, Peter D.

doi:10.1055/s-0034-1392481

Cited by 36 publications

(24 citation statements)

References 17 publications

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“…Pneumatic dilation is performed with a noncompliant, cylindrical balloon (30 mm, 35 mm or 40 mm in diameter) positioned across the LES with fluoroscopic guidance and inflated using a handheld manometer. A study published in 2015 described a modification of this technique, with the introduction of a 30 mm diameter hydraulic dilator used in conjunction with FLIP technology and not requiring concomitant fluoroscopy 55 . The standard surgical alternative to pneumatic dilation is a LHM, in which the circular muscle fibres of the LES are surgically divided.…”

Section: Lhm and Pneumatic Dilationmentioning

confidence: 99%

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Kahrilas

Bredenoord

Fox

et al. 2017

Nat Rev Gastroenterol Hepatol

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High-resolution manometry (HRM), along with the analysis algorithms characterized in the Chicago Classification (CC) first proposed in 2008, have led to a major restructuring of the classification of oesophageal motility disorders. The inherently quantitative output of HRM devices fuelled enthusiastic expectation among motility experts that these advances would add a level of precision to the diagnosis of oesophageal motility disorders that was not previously possible. Nowhere was this advance more evident than in our concept of achalasia, now differentiated into subtypes as a direct result of HRM. Coincident with the assimilation of HRM into clinical practice was the development of a major therapeutic intervention for the management of oesophageal motility disorders, per-oral endoscopic myotomy (POEM). Not only does the POEM procedure provide a therapeutic option for myotomy with reduced morbidity relative to laparoscopic or open myotomy, but it also enables a calibrated intervention that is customized to patient-specific physiology. Together, these develop ments fostered an increasing emphasis on targeting therapy to specific aspects of oesophageal dysfunction, as measured by physiological testing, rather than discrete diagnoses. Again, nowhere is this evolution more evident than in our strategies for managing achalasia. This Consensus Statement examines the effect of HRM on our current understanding of oesophageal motility disorders with a focus on how this technology has affected the diagnosis, epidemiology and management of achalasia and achalasia-like syndromes. on behalf of the International Working Group for Disorders of Gastrointestinal Motility and FunctionAbstract | High-resolution manometry (HRM) and new analysis algorithms, summarized in the Chicago Classification, have led to a restructured classification of oesophageal motility disorders. This advance has led to increased detection of clinically relevant disorders, in particular achalasia. It has become apparent that the cardinal feature of achalasia -impaired lower oesophageal sphincter (LES) relaxation -can occur in several disease phenotypes: without peristalsis (type I), with pan-oesophageal pressurization (type II), with premature (spastic) distal oesophageal contractions (type III), or with preserved peristalsis (outlet obstruction). Furthermore, no manometric pattern is perfectly sensitive or specific for achalasia caused by a myenteric plexopathy, and there is no biomarker for this pathology. Consequently, physiological testing reveals other syndromes not meeting achalasia criteria that also benefit from therapies formerly reserved for achalasia. These findings have become particularly relevant with the development of a minimally invasive technique for performing a long oesophageal myotomy, the per-oral endoscopic myotomy (POEM). Optimal management is to render treatment in a phenotype-specific manner; that is, POEM calibrated to patient-specific physiology for spastic achalasia and the spastic disorders, and more conservative strategies...

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Section: Lhm and Pneumatic Dilationmentioning

confidence: 99%

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Kahrilas

Bredenoord

Fox

et al. 2017

Nat Rev Gastroenterol Hepatol

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“…There is no intra-bag pressure sensor included with the dilation balloons and thus, the diameter alone is utilized to target and follow dilation effect 22 . A recent study demonstrated the feasibility and clinical effectiveness of using the Eso-FLIP™ achalasia hydraulic dilation balloon (maximal diameter of 30-mm) 22 . As the EGJ can be identified with a waist on the real-time display to position the balloon, this device may allow for achalasia dilation to be performed without the concurrent use of fluoroscopy.…”

Section: Achalasiamentioning

confidence: 99%

Functional Lumen Imaging Probe for the Management of Esophageal Disorders: Expert Review From the Clinical Practice Updates Committee of the AGA Institute

Hirano

Pandolfino

Boeckxstaens

2017

Clinical Gastroenterology and Hepatology

188

133

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The functional luminal imaging probe (FLIP) is an FDA approved measurement tool utilized to measure simultaneous pressure and diameter to both diagnose and manage various upper gastrointestinal disorders. Additionally, this tool is also approved to guide therapy during bariatric procedures and specialized esophageal surgery. While it has been commercially available since 2009, as the endolumenal functional lumen imaging probe (EndoFLIP ®), the FLIP has had limited penetrance into clinical settings outside of specialized centers and this is primarily due to a paucity of data supporting its utility in general practice. However, data is accumulating that is providing guidance regarding emerging applications in the evaluation and management of foregut disorders. Thus, the aim of this Clinical Practice Update is to describe the technique and review potential indications in achalasia, eosinophilic esophagitis and GERD.

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“…We recently also reported the results of the first human study in newly diagnosed idiopathic achalasia patients [16]. In this pilot study, 10 patients were dilated twice with a 30 mm balloon, with a follow-up of 3 months.…”

Section: Initial Experiencementioning

confidence: 99%

“…This requires the development of new outcome data for typical pre-and postdilation pressures as measured with the dilation balloon in achalasia patients. As with EndoFLIP measurements, we used a balloon inflation volume of 30 mL for pre-and postdilation measurements in a feasibility study [16]. This volume produces a distending pressure of approximately 70 mmHg, whereas with EndoFLIP the same inflation volume produces a pressure of approximately 15 mmHg, the difference being the result of a greater balloon stiffness of the dilation balloon [7,16].…”

Section: Egj Distensibilitymentioning

confidence: 99%

“…As with EndoFLIP measurements, we used a balloon inflation volume of 30 mL for pre-and postdilation measurements in a feasibility study [16]. This volume produces a distending pressure of approximately 70 mmHg, whereas with EndoFLIP the same inflation volume produces a pressure of approximately 15 mmHg, the difference being the result of a greater balloon stiffness of the dilation balloon [7,16]. More reference data are required before the EsoFLIP data can be used to predict outcomes in clinical practice.…”

Section: Egj Distensibilitymentioning

confidence: 99%

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Esophagogastric junction distensibility measurements during hydraulic dilation therapy in achalasia patients

Kappelle

Bogte

Siersema

2016

Expert Review of Medical Devices

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SUMMARYIncreasing evidence suggests that esophagogastric junction (EGJ) distensibility is predictive of long-term clinical success after achalasia treatment. A new commercially available hydraulic dilation balloon is capable of measuring EGJ opening diameters whilst simultaneously dilating the EGJ. Deployed alongside the endoscope under direct visualization, it is used for dilation of the lower esophageal sphincter in patients with achalasia. Impedance measurement electrodes are incorporated in the catheter shaft in the dilation balloon, which allows measuring the diameter of the EGJ and displaying it in real time before, during and after dilation. This obviates the need for fluoroscopy during the dilation procedure. The extent of recoil of the EGJ after dilation potentially provides a measurement that could be incorporated into a clinical rule for predicting therapeutic success after dilation. ARTICLE HISTORY

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Hydraulic dilation with a shape-measuring balloon in idiopathic achalasia: a feasibility study

Cited by 36 publications

References 17 publications

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Functional Lumen Imaging Probe for the Management of Esophageal Disorders: Expert Review From the Clinical Practice Updates Committee of the AGA Institute

Esophagogastric junction distensibility measurements during hydraulic dilation therapy in achalasia patients

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