Changes in impedance planimetry metrics predict clinical response to flexible endoscopy in Zenkerʼs diverticulotomy

Abstract

Background and study aims Various techniques have been described for flexible endoscopic therapy for Zenkerʼs diverticulum (ZD). Objective methods to assess myotomy effectiveness are lacking. We assessed the utility of impedance planimetry in flexible endoscopic ZD therapies and correlation with a validated symptom score.

Patients and methods Patients undergoing endoscopic therapy for symptomatic ZD from February 2019 to March 2020 were included. Intraprocedural impedance planimetry was performed pre- and post-myotomy to assess esophageal diameter and distensibility index (DI). Eating Assessment Tool (EAT)-10 scores were assessed preintervention and post-intervention. Descriptive statistics were calculated.

Results Thirteen patients (46 % women; mean age 80 years; 77 % peroral endoscopic myotomy technique) were included. Technical and clinical success was 100 %. No adverse events occurred. At 40 mL and 50 mL, the diameter improved (mean 2.3 mm and 2.6 mm, respectively). At 40 mL and 50 mL, the DI improved (mean 1.0 mm²/mmHg and 1.8 mm²/mmHg, respectively). EAT-10 scores improved by a mean of 15 points. Mean follow-up was 97 days.

Conclusions Intraprocedural impedance planimetry may provide objective data to define success for flexible endoscopic ZD. Further research is required to corroborate these results.

Publikationsverlauf

Eingereicht: 10. Juli 2020

Angenommen: 05. Oktober 2020

Artikel online veröffentlicht:
01. Januar 2021

• References

• 1 Watemberg S, Landau O, Avrahami R. Zenkerʼs diverticulum: reappraisal. Am J Gastroenterol 1996; 91: 1494-1498
• 2 Law R, Katzka DA, Baron TH. Zenkerʼs diverticulum. Clin Gastroenterol Hepatol 2014; 12: 1773-e112
• 3 Yuan Y, Zhao YF, Hu Y. et al. Surgical treatment of Zenkerʼs diverticulum. Dig Surg 2013; 30: 207-218
• 4 Ishaq S, Sultan H, Siau K. et al. New and emerging techniques for endoscopic treatment of Zenkerʼs diverticulum: State-of-the-art review. Dig Endosc 2018; 30: 449-460
• 5 Li QL, Chen WF, Zhang XC. et al. Submucosal tunneling endoscopic septum division: a novel technique for treating Zenkerʼs diverticulum. Gastroenterology 2016; 151: 1071-1074
• 6 Yang J, Novak S, Ujiki M. et al. An international study on the use of peroral endoscopic myotomy in the management of Zenkerʼs diverticulum. Gastrointest Endosc 2020; 91: 163-168
• 7 Mantsopoulos K, Psychogios G, Karatzanis A. et al. Clinical relevance and prognostic value of radiographic findings in Zenkerʼs diverticulum. Eur Arch Otorhinolaryngol 2014; 271: 583-588
• 8 Hirano I, Pandolfino JE, Boeckxstaens GE. Functional lumen imaging probe for the management of esophageal disorders: expert review from the Clinical Practice Updates Committee of the AGA Institute. Clin Gastroenterol Hepatol 2017; 15: 325-334
• 9 Vosoughi K, Ichkhanian Y, Jacques J. et al. Role of endoscopic functional luminal imaging probe in predicting the outcome of gastric peroral endoscopic pyloromyotomy (with video). Gastrointest Endosc 2020; 91: 1289-1299
• 10 Fernández-Rosati J, Lera L, Fuentes-López E. et al. Validation of the eat-10 score to detect dysphagia in older people. Rev Med Chil 2018; 146: 1008-1015
• 11 Belafsky PC, Mouadeb DA, Rees CJ. et al. Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol 2008; 117: 919-924
• 12 Sondhi AR, Watts LS, Baker JR. et al. Functional luminal imaging probe technology to assess response after flexible endoscopic Zenker diverticulotomy. VideoGIE 2019; 4: 551-553
• 13 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
• 14 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
• 15 Su B, Callahan ZM, Novak S. et al. Using impedance planimetry (EndoFLIP) to evaluate myotomy and predict outcomes after surgery for achalasia. J Gastrointest Surg 2020; 24: 964-971
• 16 Regan J, Walshe M, Rommel N. et al. New measures of upper esophageal sphincter distensibility and opening patterns during swallowing in healthy subjects using EndoFLIP^® . Neurogastroenterol Motil 2013; 25: e25-e34