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

• Published in: Gut and liver Vol. 13; no. 1; pp. 32 - 39
• Main Authors: In Kyung Yoo, Sang Ah Choi, Won Hee Kim, Sung Pyo Hong, Ozlem Ozer Cakir, Joo Young Cho
• Format: Journal Article
• Language: Korean
• Published: 대한소화기학회 30.01.2019
• Subjects: Esophageal achalasia; Functional lumen imaging probe; Peroral endoscopic my-otomy; Treatment outcome
• ISSN: 1976-2283

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 distensi-bility 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. (Gut Liver 2019;13:32-39.)