UTILITY OF THE Endo-FLIP SYSTEM FOR PREDICTING CLINICAL OUTCOMES AFTER PEROAL ENDOSCOPIC MYOTOMY (POEM) IN PATIENTS WITH ACHALASIA

Aims To demonstrate that Endo-FLIP is a tool that can enhance the precision and effectiveness of POEM.

Methods A retrospective cohort study was conducted with 40 patients who underwent POEM between May 2022 and April 2024. Demographic, clinical, endoscopic, and manometric variables were collected before and after the procedure. Treatment efficacy was evaluated three months post-POEM using the Eckardt and GERD-Q scales, as well as follow-up endoscopy. Endo-FLIP was used in 22 patients to measure intraoperative esophageal distensibility index (DI). Pearson correlation was performed between Endo-FLIP measurements and clinical outcomes.

Results General characteristics of the 40 patients undergoing POEM are presented in Table 1. The mean esophageal DI measured with Endo-FLIP significantly increased from 9.3 mm (SD=3.6) to 12.1 mm (SD=3.1) after the procedure, with a mean increase of 2.8 mm (SD=1.8) (p<0.001). The Eckardt score improved significantly, decreasing from a mean score of 5.8 (SD=1.8) to 1.13 (SD=1.38), with a mean reduction of 4.7 (SD=2) (p<0.001). Additionally, the esophageal manometry IRP4 decreased from 31.8 mmHg (SD=10.8) to 11.6 mmHg (SD=8.4), with a mean reduction of 20.4 mmHg (SD=13.5) (p<0.001) [1].

The increase in DI measured with Endo-FLIP showed a significant negative correlation with post-POEM IRP4 (r=-0.67, p=0.02) (Figure 1). An increase in DI greater than 2 mm was significantly correlated with IRP4 reduction (p=0.04). No significant correlation was observed between DI increase and Eckardt score reduction post-POEM.

Clinical success, defined as a reduction of 3 or more points in the Eckardt score, was achieved in all cases. None of the studied variables were associated with post-POEM clinical failure. Male patients showed a higher risk of post-POEM gastroesophageal reflux compared to female patients (45.8% vs. 12.5%, p=0.03; RR=5.9; 95% CI: 1.1-31). Peptic esophagitis on follow-up endoscopy was also associated with a higher incidence of symptomatic reflux (72.7% vs. 27.2%, p=0.001; RR=3; 95% CI: 1.1-8).

Conclusions 1. Intraoperative Endo-FLIP provides valuable information on procedural success, demonstrating a strong correlation with post-POEM esophageal manometry. 2. Post-POEM reflux risk is higher in male patients and in those with peptic esophagitis. Further studies are required to assess the utility of Endo-FLIP as a predictive tool for post-POEM reflux development.

Publication History

Article published online:
27 March 2025

• References

• 1 Yeung F, Wong IYH, Chung PHY, Wong KKY, Law SYK, Tam PKH.. Peroral Endoscopic Myotomy with EndoFLIP and Double-Endoscope: Novel Techniques for Achalasia in Pediatric Population. J Laparoendosc Adv Surg Tech A 2018; 28 (03): 343-347 Epub 2017 Dec 7. PMID: 29215957