Intraoperative FLIP distensibility during POEM varies according to achalasia subtype

Holmstrom, Amy L.; Campagna, Ryan A J; Alhalel, Jonathan; Carlson, Dustin A.; Pandolfino, John E.; Hungness, Eric S.; Teitelbaum, Ezra N.

doi:10.1007/s00464-020-07740-z

Cited by 14 publications

(7 citation statements)

References 19 publications

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“…Other intraoperative EndoFLIP studies on panometry included fewer than 50 patients and were conducted in the same hospital that invented panometery. [24][25][26] However, our study is meaningful as it included the largest number of patients among intraoperative EndoFLIP panometry studies to date.…”

Section: Supplementary Materialsmentioning

confidence: 99%

The Predictive Value of Intraoperative Esophageal Functional Luminal Imaging Probe Panometry in Patients With Achalasia Undergoing Peroral Endoscopic Myotomy: A Single-center Experience

Hsing

Jung

et al. 2022

J Neurogastroenterol Motil

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Background/AimsWe evaluated the clinical significance and prognostic power of functional luminal imaging probe (FLIP) panometry in patients with achalasia treated with peroral endoscopic myotomy (POEM), and examined the clinical parameters associated with symptomatic improvement and the presence of contractility (POC) following POEM. MethodsWe reviewed the electronic medical records of patients with achalasia treated with FLIP panometry and POEM at a tertiary teaching hospital in Seoul, Republic of Korea. Follow-up examination was composed of esophageal manometry and questionnaires on symptoms. We analyzed the FLIP data by interpolating using the cubic spline method in MATLAB. ResultsWe retrospectively analyzed 33 men and 35 women (mean age: 52 ± 17 years), of whom 14, 39, and 15 patients were diagnosed with achalasia types I, II, and III, respectively. The FLIP panometry diagnoses were reduced esophagogastric junction opening (REO) with a retrograde contractile response (n = 43); REO with an absent contractile response (n = 5); REO with a normal contractile response (n = 11); and a retrograde contractile response (n = 9). Overall, the patients showed improvements in Eckardt scores following POEM from 6.48 ± 2.20 to 1.16 ± 1.15 (P < 0.01). Post-POEM symptomatic improvement was not significantly associated with any of the clinical parameters, including panometry diagnosis. Conversely, post-POEM POC was significantly associated with the presence of repetitive antegrade contractions and achalasia subtypes (both P < 0.01). ConclusionWhile FLIP panometry was not significantly associated with the clinical course of achalasia, FLIP panometry was associated with POC following POEM and may complement manometry in the functional evaluation of esophageal motility disorders.

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Section: Supplementary Materialsmentioning

confidence: 99%

The Predictive Value of Intraoperative Esophageal Functional Luminal Imaging Probe Panometry in Patients With Achalasia Undergoing Peroral Endoscopic Myotomy: A Single-center Experience

Hsing

Jung

et al. 2022

J Neurogastroenterol Motil

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“…Foregut 2 (3) laparoscopic Heller myotomy and POEM offer durable symptom control regardless of achalasia subtype.…”

Section: Declaration Of Conflicting Interestsmentioning

confidence: 99%

“…There are baseline differences in DI among achalasia subtypes and these differences persist post endoscopic treatment. 3…”

Section: Introductionmentioning

confidence: 99%

“…There are baseline differences in DI among achalasia subtypes and these differences persist post endoscopic treatment. 3 However, as a clinician, is the treatment for each subtype really different? Further, after you have established a diagnosis and ruled-out any causes of pseudo-achalasia, should you treat Type III achalasia any different than Type I or II achalasia?…”

Section: Introductionmentioning

confidence: 99%

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Does Achalasia Subtype III Need to Be Treated Differently Than Type I and II? Con Argument

Worrell

2022

Foregut: The Journal of the American Foregut Society

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Prior to the introduction of high-resolution manometry (HRM), achalasia was a singular diagnosis based on water-perfused pull-through manometry. With the introduction of high-resolution manometry and the Chicago classification system, we have become more astute to the variations in motility disorders that result in failure of the lower esophageal sphincter with disordered esophageal peristalsis. However, as a clinician, is the treatment for each subtype really different? Further, after you have established a diagnosis and ruled-out any causes of pseudo-achalasia, should you treat Type III achalasia any different than Type I or II achalasia?

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“…Reider et al showed improvements in EGJ-DI on FLIP panometry performed immediately after POEM completion in EGJOO patients, with post-POEM EGJ-DI measurements similar to those of healthy controls [49]. Holmstrom et al performed FLIP intraoperatively for 125 patients with achalasia and 17 patients with EGJOO undergoing POEM, demonstrating substantial increases in EGJ-DI after POEM [50]. In another study of 143 patients with achalasia or EGJOO undergoing POEM, Holmstrom et al demonstrated that achalasia patients who underwent intraoperative FLIP-guided myotomy had a higher clinical success rate (defined as Eckardt score ≤3) at 12 months compared to those who did not (93% with FLIP vs. 81% without FLIP, P < 0.05); 65% of the patients who had intraoperative FLIP had additional myotomy performed (during the same POEM procedure) based on FLIP measurements indicating that the initial myotomy did not increase the EGJ-DI adequately [51].…”

Section: Functional Luminal Imaging Probe Panometry Guiding Esophagog...mentioning

confidence: 99%

Functional luminal imaging probe in the evaluation of esophago-gastric junction outflow obstruction

Ellison

Nguyen²

2022

Current Opinion in Gastroenterology

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Purpose of reviewEsophagogastric junction outflow obstruction (EGJOO) comprises a heterogeneous group of conditions that demonstrate impaired deglutitive relaxation of the esophagogastric junction (EGJ) with intact esophageal peristalsis on high-resolution manometry. Functional luminal imaging probe (FLIP) panometry is a powerful tool that can help to clarify the etiology of this manometric diagnosis. The aim of this review is to summarize the use of FLIP for the evaluation and management of EGJOO.Recent findingsFLIP panometry provides measures of esophageal compliance at the EGJ and information on esophageal body contractile responses to balloon distention that have important implications for the management of patients with EGJOO. After excluding anatomic causes of impaired EGJ distensibility, FLIP panometry is useful in differentiating true lower esophageal sphincter dysfunction from manometric artifact. FLIP panometry has been shown to be useful in determining the need for invasive treatment in patients with EGJOO, and in intraoperative tailoring of myotomy procedures.SummaryFLIP panometry is easy to perform during endoscopy and provides useful information for characterizing the EGJOO population. FLIP panometry can be used to guide treatment and improve outcomes in the management of patients with EGJOO.

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Intraoperative FLIP distensibility during POEM varies according to achalasia subtype

Cited by 14 publications

References 19 publications

The Predictive Value of Intraoperative Esophageal Functional Luminal Imaging Probe Panometry in Patients With Achalasia Undergoing Peroral Endoscopic Myotomy: A Single-center Experience

The Predictive Value of Intraoperative Esophageal Functional Luminal Imaging Probe Panometry in Patients With Achalasia Undergoing Peroral Endoscopic Myotomy: A Single-center Experience

Does Achalasia Subtype III Need to Be Treated Differently Than Type I and II? Con Argument

Functional luminal imaging probe in the evaluation of esophago-gastric junction outflow obstruction

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