Using Impedance Planimetry (EndoFLIP) to Evaluate Myotomy and Predict Outcomes After Surgery for Achalasia.
J Gastrointest Surg
; 24(4): 964-971, 2020 04.
Article
en En
| MEDLINE
| ID: mdl-31939098
ABSTRACT
BACKGROUND:
The functional lumen imaging probe (FLIP) is an innovative tool that uses impedance planimetry to assess esophageal geometry in real time. It has been used to diagnose achalasia and evaluate treatment failure after laparoscopic Heller myotomy (LHM) and peroral endoscopic myotomy (POEM). We hypothesize that impedance planimetry can be utilized intra-operatively to assess adequacy of myotomy and assist in predicting patient outcomes.METHODS:
A prospectively maintained patient database at a single center was queried. Seventy-seven patients with achalasia underwent POEM or LHM by a single surgeon. The FLIP was used to measure cross-sectional area (CSA), minimum diameter (Dmin), balloon pressure, and distensibility index (DI) of the lower esophageal sphincter (LES) before and after the procedure. Clinical outcomes were measured up to 2 years after treatment.RESULTS:
Post-operative CSA, Dmin, balloon pressure, and DI values were significantly different from pre-operative values (p < 0.001). Patients with a post-operative Eckardt score ≥ 3 were significantly more likely to have a final DI ≤ 3.1 mm2/mmHg (p = 0.014) or a change in DI ≤ 3.0 mm2/mmHg (p = 0.010). Additionally, a final CSA > 96 mm2 or Dmin > 11.0 mm was predictive of worse reflux at 2 years (p = 0.01).CONCLUSION:
Impedance planimetry using the FLIP can offer intra-operative feedback about the geometry of the LES. The most useful parameters in predicting patient outcomes have yet to be clearly defined, but our results demonstrate that final DI and CSA are predictive of post-operative treatment response.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Acalasia del Esófago
/
Cirugía Endoscópica por Orificios Naturales
/
Miotomía de Heller
/
Miotomía
Tipo de estudio:
Diagnostic_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Humans
Idioma:
En
Revista:
J Gastrointest Surg
Asunto de la revista:
GASTROENTEROLOGIA
Año:
2020
Tipo del documento:
Article
País de afiliación:
Estados Unidos