EoE Module 1 References-Teitelbaum et al Surg Endosc 2015 Esophagogastric junction distensibility measurement during Heller myotomy and POEM

Teitelbaum et al Surg Endosc 2015 Esophagogastric junction distensibility measurement during Heller myotomy and POEM

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This study explores the use of the functional lumen imaging probe (FLIP) to measure esophagogastric junction (EGJ) distensibility during laparoscopic Heller myotomy (LHM) and peroral esophageal myotomy (POEM) for achalasia and its predictive value for postoperative outcomes. The study involved 56 patients, 20 undergoing LHM and 36 POEM, with intraoperative FLIP measurements taken at baseline (after anesthesia induction) and after surgery completion.<br /><br />Results indicated that both procedures increased EGJ distensibility, though POEM showed a more significant increase. Patients with greater distensibility improvements via LHM reported better postoperative Eckardt scores, denoting fewer achalasia symptoms. In the POEM group, while there was no direct correlation between distensibility change and symptoms, all patients showed a DI increase of at least 3 mm²/mmHg.<br /><br />Notably, patients were divided into thirds based on final DI. None in the lowest DI group (≤6 mm²/mmHg) had symptoms of gastroesophageal reflux (GER), whereas higher distensibility correlated with more GER symptoms. An "ideal" DI range (4.5-8.5 mm²/mmHg) was established, within which 88% of patients achieved optimal outcomes (minimal achalasia and GER symptoms), compared to 47% outside this range.<br /><br />The study suggests that intraoperative FLIP measurements can serve as a precise tool for ensuring effective myotomy by predicting postoperative symptomatic relief and the potential for GER. By calibrating EGJ distensibility intraoperatively, significant improvements in patient outcomes post-achalasia surgery could be achieved.<br /><br />In conclusion, incorporating FLIP into surgical procedures for achalasia could refine intraoperative decisions, potentially optimizing patient outcomes by balancing adequate myotomy with the minimization of reflux symptoms. Further studies are needed to affirm these findings and fully integrate FLIP into clinical practice.

Keywords

FLIP

EGJ distensibility

laparoscopic Heller myotomy

peroral esophageal myotomy

achalasia

postoperative outcomes

Eckardt scores

gastroesophageal reflux

intraoperative measurements

patient outcomes