Gut Liver.  2019 Jan;13(1):32-39. 10.5009/gnl18233.

Assessment of Clinical Outcomes after Peroral Endoscopic Myotomy via Esophageal Distensibility Measurements with the Endoluminal Functional Lumen Imaging Probe

• Yoo IK
• Choi SA
• Kim WH
• Hong SP
• Cakir OO
• Cho JY

• KMID: 2434388
• DOI: http://doi.org/10.5009/gnl18233

Abstract

BACKGROUND/AIMS
Endoluminal functional lumen imaging probe (EndoFLIP) is a modality that enables clinicians to measure volume-controlled distension of the esophagus. This study aimed to assess the utility of EndoFLIP in patients who had achalasia treated with peroral endoscopic myotomy (POEM). We hypothesized that improvement in the distensibility index (DI) is correlated with the postoperative clinical outcome of POEM.
METHODS
Patients who underwent POEM for achalasia at Cha Bundang Medical Center were included. Physiological measurements of the lower esophageal sphincter (LES) pressure before and after POEM were assessed using EndoFLIP. Patients' symptoms were recorded using the Eckardt score.
RESULTS
A total of 52 patients with achalasia were included in this study. Patients with a post-POEM DI below 7 (30 or 40 mL) had a significantly higher rate of incomplete response after POEM (p=0.001). Changes in LES pressure or integrated relaxation pressure after POEM were also significantly associated with an incomplete response (p=0.026 and p=0.016, respectively). Multivariate analysis showed that post-POEM DI < 7 was the most important predictor of an incomplete response after POEM (p=0.004).
CONCLUSIONS
Lower post-POEM DI values were associated with an incomplete post-POEM response. Therefore, post-POEM DI at the esophagogastric junction using EndoFLIP is a useful index for predicting the clinical outcome of POEM in patients with achalasia.

Keyword

Esophageal achalasia; Peroral endoscopic myotomy; Functional lumen imaging probe; Treatment outcome

MeSH Terms

Esophageal Achalasia
Esophageal Sphincter, Lower
Esophagogastric Junction
Esophagus
Humans
Multivariate Analysis
Relaxation
Treatment Outcome