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20.10.2015 | Ausgabe 7/2016

Surgical Endoscopy 7/2016

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

Zeitschrift:
Surgical Endoscopy > Ausgabe 7/2016
Autoren:
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 M. Stein, Anthony N. Kalloo, Michel Kahaleh, Mouen A. Khashab
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s00464-015-4574-2) contains supplementary material, which is available to authorized users.

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.

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Zusatzmaterial
Supplementary material 1 (DOCX 12 kb)
464_2015_4574_MOESM1_ESM.docx
Literatur
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