Functional Lumen Imaging Probe to Assess Geometric Changes in the Esophagogastric Junction Following Endolumenal Fundoplication

Hoppo, Toshitaka; McMahon, Barry P.; Witteman, Bart; Kraemer, S. J. M.; O’Rourke, Robert W.; Gravesen, Flemming; Bouvy, Nicole D.; Jobe, Blair A.

doi:10.1007/s11605-011-1562-2

Cited by 39 publications

(38 citation statements)

References 14 publications

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“…Median Eckardt score before POEM was 8 (range [5][6][7][8][9][10][11][12]. Thirteen patients had a type I achalasia at high-resolution manometry; 10 a type-II.…”

Section: Resultsmentioning

confidence: 99%

EndoFLIP system for the intraoperative evaluation of peroral endoscopic myotomy

et al. 2014

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Background: Peroral endoscopic myotomy (POEM) has been recently introduced in clinical practice for the treatment of achalasia. The endoluminal functional lumen imaging probe (EndoFLIP) system) uses impedance planimetry for the realtime measurement of the diameter of the oesophago-gastric junction. Objective: The aim of this study is to prospectively evaluate the effect of POEM on the oesophago-gastric junction using EndoFLIP. Methods: All the patients who underwent POEM in a single centre between April and July 2013 were enrolled in the study. EndoFLIP was used intraoperatively, immediately before and after POEM. During follow-up patients underwent oesophagogastroduodenoscopy, oesophageal pH monitoring and manometry. Clinical outcomes were compared with the diameter of the oesophago-gastric junction after POEM. Results: In total, 23 patients (12 males, mean age 51.7 years) were enrolled, and 21 underwent POEM successfully. Preoperative mean basal lower oesophageal sphincter pressure was 42.1 mmHg (AE17.6). Before POEM, the mean oesophago-gastric junction diameter and cross-sectional area were 6.3 mm (AE1.8) and 32.9 mm 2 (AE23.1), respectively. After treatment, the mean diameter and cross-sectional area of the oesophago-gastric junction were 11.3 mm (AE1.7 SD) and 102.38 mm 2 (AE28.2 SD), respectively. No complications occurred during a mean follow-up of 5 months. Median postoperative Eckardt score was 1. Three patients (14.3%) referred heartburn. Follow-up studies revealed gastro-oesophageal reflux disease (GORD) in 57.1% of patients and oesophagitis in 33.3%. No correlations were observed between the diameter of oesophago-gastric junction after POEM and symptoms relief, GORD incidence and lower oesophageal sphincter pressure. Conclusions: The diameter of oesophago-gastric junction substantially increases after POEM. EndoFLIP is a reliable method for the intraoperative evaluation of oesophago-gastric junction diameter. However, the real usefulness of this technology after POEM remains controversial.

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“…Median Eckardt score before POEM was 8 (range [5][6][7][8][9][10][11][12]. Thirteen patients had a type I achalasia at high-resolution manometry; 10 a type-II.…”

Section: Resultsmentioning

confidence: 99%

EndoFLIP system for the intraoperative evaluation of peroral endoscopic myotomy

et al. 2014

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“…However, the CSA of both groups returned to the baseline at the 2-week follow-up. The FLIP results correlated with pH testing results and measures of EGJ structural integrity [37]. In a later explorative clinical study primarily investigating the effect of TIF on clinical parameters in patients dissatisfied with medical treatment, Rinsma et al [38] evaluated EGJ distensibility immediately before and after the TIF procedure.…”

Section: Gastroesophageal Reflux Diseasementioning

confidence: 95%

Functional lumen imaging of the gastrointestinal tract

et al. 2015

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This nonsystematic review aims to describe recent developments in the use of functional lumen imaging in the gastrointestinal tract stimulated by the introduction of the functional lumen imaging probe. When ingested food in liquid and solid form is transported along the gastrointestinal tract, sphincters provide an important role in the flow and control of these contents. Inadequate function of sphincters is the basis of many gastrointestinal diseases. Despite this, traditional methods of sphincter diagnosis and measurement such as fluoroscopy, manometry, and the barostat are limited in what they can tell us. It has long been thought that measurement of sphincter function through resistance to distension is a better approach, now more commonly known as distensibility testing. The functional lumen imaging probe is the first medical measurement device that purports in a practical way to provide geometric profiling and measurement of distensibility in sphincters. With use of impedance planimetry, an axial series of cross-sectional areas and pressure in a cathetermounted allantoid bag are used for the calculation of distensibility parameters. The technique has been trialed in many valvular areas of the gastrointestinal tract, including the upper esophageal sphincter, the esophagogastric junction, and the anorectal region. It has shown potential in the biomechanical assessment of sphincter function and characterization of swallowing disorders, gastroesophageal reflux disease, eosinophilic esophagitis, achalasia, and fecal incontinence. From this early work, the functional lumen imaging technique has the potential to contribute to a better and more physiological understanding of narrowing regions in the gastrointestinal tract in general and sphincters in particular.

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“…In addition, transmural placement of polypropylene fasteners creates an endoluminal fundoplication through permanent serosa-to-serosa or serosa-to-muscularis fusion with tightening of the distal esophagus, which decreases EGJ diameter and distensibility. 5,6 Therefore, we believe that EGJ distensibility can be an important parameter for evaluation of endoluminal gastroesophageal reflux disease (GERD) surgery like the TIF procedure, although we agree that the immediate decrease in EGJ distensibility after the TIF procedure might be the consequence of postoperative edema. 7 It is important to note that consensus is lacking with regard to analysis of parameters obtained from EndoFLIP measurements.…”

Section: To the Editormentioning

confidence: 99%