Intraoperative measurement of esophagogastric junction cross-sectional area by impedance planimetry correlates with clinical outcomes of peroral endoscopic myotomy for achalasia: a multicenter study.
Peroral endoscopic myotomy (POEM) has been introduced as an endoscopic alternative to surgical myotomy. The endoluminal functional lumen imaging probe (endoFLIP) evaluates esophagogastric junction (EGJ) distensibility based on cross-sectional area and pressure in response to volume distension. The aim of this study was to evaluate whether there is a correlation between endoFLIP measurements during POEM and postoperative clinical outcomes in terms of symptom relief and development of post-procedure reflux.



We conducted a retrospective review of achalasia patients who underwent POEM and intraoperative endoFLIP at three tertiary centers. Patients were divided into two groups based on clinical response measured by Eckardt score (ES): good response (ES < 3) or poor response (ES ≥ 3). Post-procedure reflux was defined as the presence of esophagitis and/or abnormal pH study. EGJ diameter, cross-sectional area, and distensibility measured by endoFLIP were compared.



Of the 63 treated patients, 50 had good and 13 had poor clinical response. The intraoperative final EGJ cross-sectional area was significantly higher in the good-response group versus poor-response group; median (interquartile range): 89.0 (78.5-106.7) versus 72.4 (48.8-80.0) mm(2) [p = 0.01]. The final EGJ cross-sectional area was also significantly higher in patients who had reflux esophagitis after POEM: 99.5 (91.2-103.7) versus 79.3 (57.1-94.2) mm(2) [p = 0.02].



Intraoperative EGJ cross-sectional area during POEM for achalasia correlated with clinical response and post-procedure reflux. Impedance planimetry is a potentially important tool to guide the extent and adequacy of myotomy during POEM.
Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD, USA.
Saowanee
S
Ngamruengphong
Department of General Surgery, University Hospital Wurzburg, Würzburg, Germany.
Burkhard H A
BH
von Rahden
Department of General Surgery, University Hospital Wurzburg, Würzburg, Germany.
Jörg
J
Filser
Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, USA.
Amy
A
Tyberg
Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, USA.
Amit
A
Desai
Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, USA.
Reem Z
RZ
Sharaiha
Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, USA.
Arnon
A
Lambroza
Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD, USA.
Vivek
V
Kumbhari
Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD, USA.
Mohamad
M
El Zein
Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD, USA.
Ahmed
A
Abdelgelil
Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD, USA.
Sepideh
S
Besharati
Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD, USA.
John O
JO
Clarke
Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD, USA.
Ellen M
EM
Stein
Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD, USA.
Anthony N
AN
Kalloo
Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, USA.
Michel
M
Kahaleh
Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD, USA. mkhasha1@jhmi.edu.|Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, 1800 Orleans Street, Zayed Bldg, Suite 7125B, Baltimore, MD, 21287, USA. mkhasha1@jhmi.edu.
Mouen A
MA
Khashab
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017097:Electric Impedance; D004931:Esophageal Achalasia / Q000503:physiopathology* / Q000601:surgery; D004943:Esophagogastric Junction / Q000503:physiopathology* / Q000601:surgery; D004945:Esophagoscopy / Q000379:methods; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D057605:Natural Orifice Endoscopic Surgery; D011312:Pressure; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
Achalasia; Endoluminal functional lumen imaging probe; Esophagogastric junction; Peroral endoscopic myotomy