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- Title
Intraoperative measurement of esophagogastric junction cross-sectional area by impedance planimetry correlates with clinical outcomes of peroral endoscopic myotomy for achalasia: a multicenter study.
- Authors
Ngamruengphong, Saowanee; von Rahden, Burkhard; Filser, Jörg; Tyberg, Amy; Desai, Amit; Sharaiha, Reem; Lambroza, Arnon; Kumbhari, Vivek; El Zein, Mohamad; Abdelgelil, Ahmed; Besharati, Sepideh; Clarke, John; Stein, Ellen; Kalloo, Anthony; Kahaleh, Michel; Khashab, Mouen; von Rahden, Burkhard H A; Filser, Jörg; Sharaiha, Reem Z; Clarke, John O
- Abstract
<bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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].<bold>Conclusion: </bold>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.
- Subjects
EUROPE; UNITED States; ESOPHAGOGASTRIC junction; ESOPHAGEAL achalasia; CROSS-sectional method; STATISTICAL correlation; GASTROESOPHAGEAL reflux; ESOPHAGEAL surgery; COMPARATIVE studies; ENDOSCOPY; ESOPHAGOSCOPY; ESOPHAGUS; BIOELECTRIC impedance; INTRAOPERATIVE monitoring; RESEARCH methodology; MEDICAL cooperation; PRESSURE; RESEARCH; EVALUATION research; TREATMENT effectiveness; RETROSPECTIVE studies
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2016, Vol 30, Issue 7, p2886
- ISSN
1866-6817
- Publication type
journal article
- DOI
10.1007/s00464-015-4574-2