Subscribe to RSS
Impedance planimetry values for predicting clinical response following peroral endoscopic myotomy
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.
Received: 08 January 2020
Accepted: 28 July 2020
04 November 2020 (online)
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Kim GH. Is EndoFLIP useful for predicting clinical outcomes after peroral endoscopic myotomy in patients with achalasia?. Gut Liver 2019; 13: 3-4
- 2 Rohof WO, Hirsch DP, Kessing BF. et al. Efficacy of treatment for patients with achalasia depends on the distensibility of the esophagogastric junction. Gastroenterology 2012; 143: 328-335
- 3 Ngamruengphong S, von Rahden BH, Filser J. et al. 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; 30: 2886-2894
- 4 Teitelbaum EN, Boris L, Arafat FO. et al. Comparison of esophagogastric junction distensibility changes during POEM and Heller myotomy using intraoperative FLIP. Surg Endosc 2013; 27: 4547-4555
- 5 Teitelbaum EN, Soper NJ, Pandolfino JE. et al. Esophagogastric junction distensibility measurements during Heller myotomy and POEM for achalasia predict postoperative symptomatic outcomes. Surg Endosc 2015; 29: 522-528
- 6 Yoo IK, Choi SA, Kim WH. et al. Assessment of clinical outcomes after peroral endoscopic myotomy via esophageal distensibility measurements with the endoluminal functional lumen imaging probe. Gut Liver 2019; 13: 32-39
- 7 Wu PI, Szczesniak MM, Craig PI. et al. Novel intra-procedural distensibility measurement accurately predicts immediate outcome of pneumatic dilatation for idiopathic achalasia. Am J Gastroenterol 2018; 113: 205-212
- 8 Kahrilas PJ, Bredenoord AJ, Fox M. et al. The Chicago Classification of esophageal motility disorders, v3.0. . Neurogastroenterol Motil 2015; 27: 160-174
- 9 Khashab MA, El Zein M, Kumbhari V. et al. Comprehensive analysis of efficacy and safety of peroral endoscopic myotomy performed by a gastroenterologist in the endoscopy unit: a single-center experience. Gastrointest Endosc 2016; 83: 117-125
- 10 Eckardt VF, Aignherr C, Bernhard G. Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology 1992; 103: 1732-1738
- 11 Lundell LR, Dent J, Bennett JR. et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut 1999; 45: 172-180
- 12 LeDell E, Petersen M, van der Laan M. Computationally efficient confidence intervals for cross-validated area under the ROC curve estimates. Electron J Stat 2015; 9: 1583-1607
- 13 Wolfson J. EEBoost: a general method for prediction and variable selection based on estimating equations. J Am Stat Assoc 2011; 106: 296-305
- 14 Brown B, Miller CJ, Wolfson J. ThrEEBoost: thresholded boosting for variable selection and prediction via estimating equations. J Comput Graph Stat 2017; 26: 579-588
- 15 Repici A, Fuccio L, Maselli R. et al. GERD after per-oral endoscopic myotomy as compared with Heller’s myotomy with fundoplication: a systematic review with meta-analysis. Gastrointest Endosc 2018; 87: 934-943.e918
- 16 Werner YB, Hakanson B, Martinek J. et al. Endoscopic or surgical myotomy in patients with idiopathic achalasia. N Engl J Med 2019; 381: 2219-2229
- 17 Pandolfino JE, Shi G, Curry J. et al. Esophagogastric junction distensibility: a factor contributing to sphincter incompetence. Am J Physiol Gastrointest Liver Physiol 2002; 282: G1052-1058
- 18 Smeets FG, Keszthelyi D, Masclee AA. et al. Measurement of esophagogastric junction distensibility may assist in selecting patients for endoluminal gastroesophageal reflux disease surgery: author’s reply. J Neurogastroenterol Motil 2015; 21: 450-451
- 19 Perretta S, McAnena O, Botha A. et al. Acta from the EndoFLIPâ Symposium. Surg Innov 2013; 20: 545-552
- 20 Taft TH, Carlson DA, Triggs J. et al. Evaluating the reliability and construct validity of the Eckardt symptom score as a measure of achalasia severity. Neurogastroenterol Motil 2018; 30: e13287