Intraoperative measurement of esophagogastric junction cross-sectional area by impedance planimetry correlates with clinical outcomes of peroral endoscopic myotomy for achalasia

a multicenter study

Saowanee Ngamruengphong, Burkhard H A von Rahden, Jörg Filser, Amy Tyberg, Amit Desai, Reem Z. Sharaiha, Arnon Lambroza, Vivek Kumbhari, Mohamad El Zein, Ahmed Abdelgelil, Sepideh Besharati, John O. Clarke, Ellen Stein, Anthony N Kalloo, Michel Kahaleh, Mouen Khashab

Research output: Contribution to journalArticle

Abstract

Background: 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. Methods: 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. Results: 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) mm2 [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) mm2 [p = 0.02]. Conclusion: 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.

Original languageEnglish (US)
JournalSurgical Endoscopy and Other Interventional Techniques
DOIs
StateAccepted/In press - Oct 20 2015

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Esophagogastric Junction
Esophageal Achalasia
Electric Impedance
Multicenter Studies
Peptic Esophagitis
Esophagitis
Pressure

Keywords

  • Achalasia
  • Endoluminal functional lumen imaging probe
  • Esophagogastric junction
  • Peroral endoscopic myotomy

ASJC Scopus subject areas

  • Surgery

Cite this

Intraoperative measurement of esophagogastric junction cross-sectional area by impedance planimetry correlates with clinical outcomes of peroral endoscopic myotomy for achalasia : a multicenter study. / Ngamruengphong, Saowanee; von Rahden, Burkhard H A; Filser, Jörg; Tyberg, Amy; Desai, Amit; Sharaiha, Reem Z.; Lambroza, Arnon; Kumbhari, Vivek; El Zein, Mohamad; Abdelgelil, Ahmed; Besharati, Sepideh; Clarke, John O.; Stein, Ellen; Kalloo, Anthony N; Kahaleh, Michel; Khashab, Mouen.

In: Surgical Endoscopy and Other Interventional Techniques, 20.10.2015.

Research output: Contribution to journalArticle

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title = "Intraoperative measurement of esophagogastric junction cross-sectional area by impedance planimetry correlates with clinical outcomes of peroral endoscopic myotomy for achalasia: a multicenter study",
abstract = "Background: 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. Methods: 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. Results: 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) mm2 [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) mm2 [p = 0.02]. Conclusion: 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.",
keywords = "Achalasia, Endoluminal functional lumen imaging probe, Esophagogastric junction, Peroral endoscopic myotomy",
author = "Saowanee Ngamruengphong and {von Rahden}, {Burkhard H A} and J{\"o}rg Filser and Amy Tyberg and Amit Desai and Sharaiha, {Reem Z.} and Arnon Lambroza and Vivek Kumbhari and {El Zein}, Mohamad and Ahmed Abdelgelil and Sepideh Besharati and Clarke, {John O.} and Ellen Stein and Kalloo, {Anthony N} and Michel Kahaleh and Mouen Khashab",
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T1 - Intraoperative measurement of esophagogastric junction cross-sectional area by impedance planimetry correlates with clinical outcomes of peroral endoscopic myotomy for achalasia

T2 - a multicenter study

AU - Ngamruengphong, Saowanee

AU - von Rahden, Burkhard H A

AU - Filser, Jörg

AU - Tyberg, Amy

AU - Desai, Amit

AU - Sharaiha, Reem Z.

AU - Lambroza, Arnon

AU - Kumbhari, Vivek

AU - El Zein, Mohamad

AU - Abdelgelil, Ahmed

AU - Besharati, Sepideh

AU - Clarke, John O.

AU - Stein, Ellen

AU - Kalloo, Anthony N

AU - Kahaleh, Michel

AU - Khashab, Mouen

PY - 2015/10/20

Y1 - 2015/10/20

N2 - Background: 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. Methods: 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. Results: 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) mm2 [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) mm2 [p = 0.02]. Conclusion: 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.

AB - Background: 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. Methods: 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. Results: 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) mm2 [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) mm2 [p = 0.02]. Conclusion: 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.

KW - Achalasia

KW - Endoluminal functional lumen imaging probe

KW - Esophagogastric junction

KW - Peroral endoscopic myotomy

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