Open AccessEndoFLIP system for the intraoperative evaluation of peroral endoscopic myotomy
Author(s) -
Familiari Pietro,
Gigante Giovanni,
Marchese Michele,
Boskoski Ivo,
Bove Vincenzo,
Tringali Andrea,
Perri Vincenzo,
Onder Graziano,
Costamagna Guido
Publication year - 2014
Publication title -
ueg journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 35
eISSN - 2050-6414
pISSN - 2050-6406
DOI - 10.1177/2050640614521193
Subject(s) - medicine , myotomy , achalasia , heartburn , reflux , esophagogastric junction , esophageal sphincter , gastroesophageal junction , lumen (anatomy) , gerd , surgery , esophagus , disease , adenocarcinoma , cancer
Background Peroral endoscopic myotomy (POEM) has been recently introduced in clinical practice for the treatment of achalasia. The endoluminal functional lumen imaging probe (EndoFLIP) system) uses impedance planimetry for the real‐time measurement of the diameter of the oesophago‐gastric junction. Objective The aim of this study is to prospectively evaluate the effect of POEM on the oesophago‐gastric junction using EndoFLIP. Methods All the patients who underwent POEM in a single centre between April and July 2013 were enrolled in the study. EndoFLIP was used intraoperatively, immediately before and after POEM. During follow‐up patients underwent oesophagogastroduodenoscopy, oesophageal pH monitoring and manometry. Clinical outcomes were compared with the diameter of the oesophago‐gastric junction after POEM. Results In total, 23 patients (12 males, mean age 51.7 years) were enrolled, and 21 underwent POEM successfully. Preoperative mean basal lower oesophageal sphincter pressure was 42.1 mmHg (±17.6). Before POEM, the mean oesophago‐gastric junction diameter and cross‐sectional area were 6.3 mm (±1.8) and 32.9 mm 2 (±23.1), respectively. After treatment, the mean diameter and cross‐sectional area of the oesophago‐gastric junction were 11.3 mm (±1.7 SD) and 102.38 mm 2 (±28.2 SD), respectively. No complications occurred during a mean follow‐up of 5 months. Median post‐operative Eckardt score was 1. Three patients (14.3%) referred heartburn. Follow‐up studies revealed gastro‐oesophageal reflux disease (GORD) in 57.1% of patients and oesophagitis in 33.3%. No correlations were observed between the diameter of oesophago‐gastric junction after POEM and symptoms relief, GORD incidence and lower oesophageal sphincter pressure. Conclusions The diameter of oesophago‐gastric junction substantially increases after POEM. EndoFLIP is a reliable method for the intraoperative evaluation of oesophago‐gastric junction diameter. However, the real usefulness of this technology after POEM remains controversial.