COMPARISON OF PREOPERATIVE AND POSTOPERATIVE FUNCTIONAL LUMINAL IMAGING PROBE MEASUREMENTS IN PATIENTS UNDERGOING PERORAL ENDOSCOPIC MYOTOMY FOR ACHALASIA

Aims The functional luminal imaging probe (FLIP) is a catheter-based device that measures esophagogastric junction (EGJ) distensibility. Previous studies have demonstrated that impedance planimetry measurements can predict clinical response following peroral endoscopic myotomy (POEM). This study aims to assess changes in distensibility index (DI), intraballoon pressure (IBP), cross-sectional Area (CSA) and minimum diameter (Dmin) in patients with untreated achalasia before, during and after POEM and to determine the most predictive measures for clinical response.

Methods Untreated achalasia patients undergoing POEM were prospectively enrolled. FLIP measurements including CSA, IBP, CSA and Dmin of the lower esophageal sphincter (LES) were performed (1)at the start of the POEM procedure, (2)after POEM myotomy and (3)at a routine 3-months follow-up. Measurements were reported at a 30 ml and a 40 ml fill volume for the 8 cm FLIP (EF-325). Clinical response was defined as an Eckardt score≤3 at 3-months follow-up.

Results Fourteen patients underwent FLIP measurements at time point 1 and 2. Post-operative CSA, Dmin, DI values for 30 ml and CSA, Dmin, DI and IBD values for 40 ml fill volume were significantly different from pre-operative values (30ml: 51.0(±27)mm² vs. 72.6(±28.7)mm², P=0.009; 7.7(±2.1)mm vs. 9.9(±1.5)mm, P=0.001; 2.5(±1.7)mm²/mmHg vs. 3.9(±1.3)mm²/mmHg, P=0.004; 40ml: 88.3(±41.9)mm² vs. 124.3(±32.6)mm², P=0.001; 10.3(±2.4)mm vs. 12.7(±1.8)mm,P=0.001; 2.3(±1.2)mm²/mmHg vs. 3.8(±1.3)mm²/mmHg, P=0.001; 40.5(±11.3)mmHg vs. 36.0(±8.2)mmHg,P=0.023).

Conclusions CSA, Dmin and DI improve significantly after POEM. The most predictive measures for clinical response following POEM have yet to be clarified when follow-up data are available.

 

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Artikel online veröffentlicht:
14. April 2022