Intraoperative measurement of esophagogastric junction cross-sectional area by impedance planimetry correlates with clinical outcomes of peroral endoscopic myotomy for achalasia: a multicenter study

Surg Endosc. 2016 Jul;30(7):2886-94. doi: 10.1007/s00464-015-4574-2. Epub 2015 Oct 20.

Abstract

Background: Peroral endoscopic myotomy (POEM) has been introduced as an endoscopic alternative to surgical myotomy. The endoluminal functional lumen imaging probe (endoFLIP) evaluates esophagogastric junction (EGJ) distensibility based on cross-sectional area and pressure in response to volume distension. The aim of this study was to evaluate whether there is a correlation between endoFLIP measurements during POEM and postoperative clinical outcomes in terms of symptom relief and development of post-procedure reflux.

Methods: We conducted a retrospective review of achalasia patients who underwent POEM and intraoperative endoFLIP at three tertiary centers. Patients were divided into two groups based on clinical response measured by Eckardt score (ES): good response (ES < 3) or poor response (ES ≥ 3). Post-procedure reflux was defined as the presence of esophagitis and/or abnormal pH study. EGJ diameter, cross-sectional area, and distensibility measured by endoFLIP were compared.

Results: Of the 63 treated patients, 50 had good and 13 had poor clinical response. The intraoperative final EGJ cross-sectional area was significantly higher in the good-response group versus poor-response group; median (interquartile range): 89.0 (78.5-106.7) versus 72.4 (48.8-80.0) mm(2) [p = 0.01]. The final EGJ cross-sectional area was also significantly higher in patients who had reflux esophagitis after POEM: 99.5 (91.2-103.7) versus 79.3 (57.1-94.2) mm(2) [p = 0.02].

Conclusion: Intraoperative EGJ cross-sectional area during POEM for achalasia correlated with clinical response and post-procedure reflux. Impedance planimetry is a potentially important tool to guide the extent and adequacy of myotomy during POEM.

Keywords: Achalasia; Endoluminal functional lumen imaging probe; Esophagogastric junction; Peroral endoscopic myotomy.

Publication types

  • Evaluation Study
  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Electric Impedance
  • Esophageal Achalasia / physiopathology*
  • Esophageal Achalasia / surgery
  • Esophagogastric Junction / physiopathology*
  • Esophagogastric Junction / surgery
  • Esophagoscopy / methods
  • Europe
  • Female
  • Humans
  • Male
  • Middle Aged
  • Monitoring, Intraoperative
  • Natural Orifice Endoscopic Surgery
  • Pressure
  • Retrospective Studies
  • Sensitivity and Specificity
  • Treatment Outcome
  • United States
  • Young Adult