Endoscopy 2021; 53(06): 570-577
DOI: 10.1055/a-1268-7713
Original article

Impedance planimetry values for predicting clinical response following peroral endoscopic myotomy

Robert A. Moran
 1  Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, United States
 2  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Olaya I. Brewer Gutierrez
 1  Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, United States
,
Burkhard Rahden
 3  Department of Surgery Paracelsus, Medical Private Unviersity, Salzburg, Austria
,
Kenneth Chang
 4  Department of Gastroenterology, University of California Irvine Health, Irvine, California, United States
,
Michael Ujiki
 5  Department of Gastroenterology, North Shore University Health System, Evanston, Illinois, United States
,
In Kyung Yoo
 6  Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
,
Shraddha Gulati
 7  Department of Gastroenterology, King’s College Hospital, London, United Kingdom
,
John Romanelli
 8  Department of Gastroenterology, University of Massachusetts Medical School/Baystate, Baystate Medical Center, Springfield, Massachusetts, United States
,
Mohammed Al-Nasser
 3  Department of Surgery Paracelsus, Medical Private Unviersity, Salzburg, Austria
,
Toshitaka Shimizu
 4  Department of Gastroenterology, University of California Irvine Health, Irvine, California, United States
,
Mason H. Hedberg
 9  Department of Gastroenterology, University of Chicago Medical Center, Chicago, Illinois, United States
,
Joo Young Cho
 6  Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
,
Bu Hayee
 7  Department of Gastroenterology, King’s College Hospital, London, United Kingdom
,
David Desilets
 8  Department of Gastroenterology, University of Massachusetts Medical School/Baystate, Baystate Medical Center, Springfield, Massachusetts, United States
,
Jörg Filser
10  Department of Surgery, InnKlinikum Altötting, Altötting, Germany
,
Kyle Fortinsky
 4  Department of Gastroenterology, University of California Irvine Health, Irvine, California, United States
,
Amyn Haji
 7  Department of Gastroenterology, King’s College Hospital, London, United Kingdom
,
Lea Fayad
 2  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Omid Sanaei
 2  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Mohamad Dbouk
 2  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Vivek Kumbhari
 2  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Bethany J. Wolf
11  Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States
,
B. Joseph Elmunzer
 1  Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, United States
,
Mouen A. Khashab
 2  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
› Author Affiliations

Abstract

Background There is growing interest in developing impedance planimetry as a tool to enhance the clinical outcomes for endoscopic and surgical management of achalasia. The primary aim of this study was to determine whether impedance planimetry measurements can predict clinical response and reflux following peroral endoscopic myotomy (POEM).

Methods A multicenter cohort study of patients with achalasia undergoing POEM was established from prospective databases and retrospective chart reviews. Patients who underwent impedance planimetry before and after POEM were included. Clinical response was defined as an Eckardt score of ≤ 3. Tenfold cross-validated area under curve (AUC) values were established for the different impedance planimetry measurements associated with clinical response and reflux development.

Results Of the 290 patients included, 91.7 % (266/290) had a clinical response and 39.4 % (108/274) developed reflux following POEM. The most predictive impedance planimetry measurements for a clinical response were: percent change in cross-sectional area (%ΔCSA) and percent change in distensibility index (%ΔDI), with AUCs of 0.75 and 0.73, respectively. Optimal cutoff values for %ΔCSA and %ΔDI to determine a clinical response were a change of 360 % and 272 %, respectively. Impedance planimetry values were much poorer at predicting post-POEM reflux, with AUCs ranging from 0.40 to 0.62.

Conclusion Percent change in CSA and distensibility index were the most predictive measures of a clinical response, with a moderate predictive ability. Impedance planimetry values for predicting reflux following POEM showed weak predictive capacity.

Figs. 1 – 3



Publication History

Received: 08 January 2020

Accepted: 28 July 2020

Publication Date:
04 November 2020 (online)

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