EndoFLIP system for the intraoperative evaluation of peroral endoscopic myotomy. Issue 2 (April 2014)

• Record Type: Journal Article
• Authors: Familiari, Pietro; Gigante, Giovanni; Marchese, Michele; Boskoski, Ivo; Bove, Vincenzo; Tringali, Andrea; Perri, Vincenzo; Onder, Graziano; Costamagna, Guido
• Is Part Of: United European Gastroenterology journal. Volume 2:Issue 2(2014:Apr.)
• Page Start: 77
• Page End: 83
• Publication Date: 2014-04
• Subjects: Achalasia -- peroral endoscopic myotomy -- EndoFLIP -- oesophago-gastric junction -- oesophageal manometry -- oesophagus -- endoscopy; Gastroenterology -- Periodicals; Periodicals; 616.33005
• DOI: 10.1177/2050640614521193
• Languages: English
• ISSNs: 2050-6406

Abstract

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 real-time 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 (±17.6). Before POEM, the mean oesophago-gastric junction diameter and cross-sectional area were 6.3 mm (±1.8) and 32.9 mm 2 (±23.1), respectively. After treatment, the mean diameter and cross-sectional area of the oesophago-gastric junction were 11.3 mm (±1.7 SD) and 102.38 mm 2 (±28.2 SD), respectively. No complications occurred during a mean follow-up of 5 months. Median post-operative 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.