Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 3/2015

01-03-2015

Esophagogastric junction distensibility measurements during Heller myotomy and POEM for achalasia predict postoperative symptomatic outcomes

Authors: Ezra N. Teitelbaum, Nathaniel J. Soper, John E. Pandolfino, Peter J. Kahrilas, Ikuo Hirano, Lubomyr Boris, Frédéric Nicodème, Zhiyue Lin, Eric S. Hungness

Published in: Surgical Endoscopy | Issue 3/2015

Login to get access

Abstract

Background

The functional lumen imaging probe (FLIP) is a novel diagnostic tool that can be used to measure esophagogastric junction (EGJ) distensibility. In this study, we performed intraoperative FLIP measurements during laparoscopic Heller myotomy (LHM) and peroral esophageal myotomy (POEM) for treatment of achalasia and evaluated the relationship between EGJ distensibility and postoperative symptoms.

Methods

Distensibility index (DI) (defined as the minimum cross-sectional area at the EGJ divided by distensive pressure) was measured with FLIP at two time points during LHM and POEM: (1) at baseline after induction of anesthesia, and (2) after operation completion.

Results

Measurements were performed in 20 patients undergoing LHM and 36 undergoing POEM. Both operations resulted in an increase in DI, although this increase was larger with POEM (7 ± 3.1 vs. 5.1 ± 3.4 mm2/mmHg, p < .05). The two patients (both LHM) with the smallest increases in DI (1 and 1.6 mm2/mmHg) both had persistent symptoms postoperatively and, overall, LHM patients with larger increases in DI had lower postoperative Eckardt scores. In the POEM group, there was no correlation between change in DI and symptoms; however, all POEM patients experienced an increase in DI of >3 mm2/mmHg. When all patients were divided into thirds based on final DI, none in the lowest DI group (<6 mm2/mmHg) had symptoms suggestive of reflux (i.e., GerdQ score >7), as compared with 20 % in the middle third (6–9 mm2/mmHg) and 36 % in the highest third (>9 mm2/mmHg). Patients within an “ideal” final DI range (4.5–8.5 mm2/mmHg) had optimal symptomatic outcomes (i.e., Eckardt ≤ 1 and GerdQ ≤ 7) in 88 % of cases, compared with 47 % in those with a final DI above or below that range (p < .05).

Conclusions

Intraoperative EGJ distensibility measurements with FLIP were predictive of postoperative symptomatic outcomes. These results provide initial evidence that FLIP has the potential to act as a useful calibration tool during operations for achalasia.
Literature
1.
Triadafilopoulos G, Boeckxstaens GE, Gullo R, Patti MG, Pandolfino JE, Kahrilas PJ, Duranceau A, Jamieson G, Zaninotto G (2012) The Kagoshima consensus on esophageal achalasia. Dis Esophagus 25:337–348PubMedCrossRef
2.
Boeckxstaens GE, Annese V, des Varannes SB, Chaussade S, Costantini M, Cuttitta A, Elizalde JI, Fumagalli U, Gaudric M, Rohof WO, Smout AJ, Tack J, Zwinderman AH, Zaninotto G, Busch OR, European Achalasia Trial I (2011) Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. N Engl J Med 364:1807–1816PubMedCrossRef
3.
Campos GM, Vittinghoff E, Rabl C, Takata M, Gadenstatter M, Lin F, Ciovica R (2009) Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg 249:45–57PubMedCrossRef
4.
Yaghoobi M, Mayrand S, Martel M, Roshan-Afshar I, Bijarchi R, Barkun A (2013) Laparoscopic Heller’s myotomy versus pneumatic dilation in the treatment of idiopathic achalasia: a meta-analysis of randomized, controlled trials. Gastrointest Endosc 78:468–475PubMedCrossRef
5.
Novais PA, Lemme EM (2010) 24-h pH monitoring patterns and clinical response after achalasia treatment with pneumatic dilation or laparoscopic Heller myotomy. Aliment Pharmacol Ther 32:1257–1265PubMedCrossRef
6.
Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, Satodate H, Odaka N, Itoh H, Kudo S (2010) Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 42:265–271PubMedCrossRef
7.
Hungness ES, Teitelbaum EN, Santos BF, Arafat FO, Pandolfino JE, Kahrilas PJ, Soper NJ (2013) Comparison of perioperative outcomes between peroral esophageal myotomy (POEM) and laparoscopic Heller myotomy. J Gastrointest Surg 17:228–235PubMedCrossRef
8.
Bhayani NH, Kurian AA, Dunst CM, Sharata AM, Rieder E, Swanstrom LL (2013) A comparative study on comprehensive, objective outcomes of laparoscopic heller myotomy with per-oral endoscopic myotomy (POEM) for achalasia. Ann Surg 259(6):1098–1103CrossRef
9.
Pandolfino JE, de Ruigh A, Nicodeme F, Xiao Y, Boris L, Kahrilas PJ (2013) Distensibility of the esophagogastric junction assessed with the functional lumen imaging probe (FLIP) in achalasia patients. Neurogastroenterol Motil 25:496–501PubMedCentralPubMedCrossRef
10.
Rohof WO, Hirsch DP, Kessing BF, Boeckxstaens GE (2012) Efficacy of treatment for patients with achalasia depends on the distensibility of the esophagogastric junction. Gastroenterology 143:328–335PubMedCrossRef
11.
Teitelbaum EN, Boris L, Arafat FO, Nicodeme F, Lin ZY, Kahrilas PJ, Pandolfino JE, Soper NJ, Hungness ES (2013) Comparison of esophagogastric junction distensibility changes during POEM and Heller myotomy using intraoperative FLIP. Surg Endosc 27:4547–4555PubMedCrossRef
12.
Eckardt VF (2001) Clinical presentations and complications of achalasia. Gastrointest Endosc Clin N Am 11:281–292PubMed
13.
Clouse RE, Staiano A, Alrakawi A, Haroian L (2000) Application of topographical methods to clinical esophageal manometry. Am J Gastroenterol 95:2720–2730PubMedCrossRef
14.
Bredenoord AJ, Fox M, Kahrilas PJ, Pandolfino JE, Schwizer W, Smout AJ, International High Resolution Manometry Working G (2012) Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography. Neurogastroenterol Motil 24(Suppl 1):57–65PubMedCentralPubMedCrossRef
15.
Vaziri K, Soper NJ (2008) Laparoscopic Heller myotomy: technical aspects and operative pitfalls. J Gastrointest Surg 12:1586–1591PubMedCrossRef
16.
McMahon BP, Frokjaer JB, Kunwald P, Liao D, Funch-Jensen P, Drewes AM, Gregersen H (2007) The functional lumen imaging probe (FLIP) for evaluation of the esophagogastric junction. Am J Physiol Gastrointest Liver Physiol 292:G377–G384PubMedCrossRef
17.
Perretta S, McAnena O, Botha A, Nathanson L, Swanstrom L, Soper NJ, Inoue H, Ponsky J, Jobe B, Marescaux J, Dallemagne B (2013) Acta from the EndoFLIP(R) Symposium. Surg Innov
18.
Jones R, Junghard O, Dent J, Vakil N, Halling K, Wernersson B, Lind T (2009) Development of the GerdQ, a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care. Aliment Pharmacol Ther 30:1030–1038PubMedCrossRef
19.
Kwiatek MA, Pandolfino JE, Hirano I, Kahrilas PJ (2010) Esophagogastric junction distensibility assessed with an endoscopic functional luminal imaging probe (EndoFLIP). Gastrointest Endosc 72:272–278PubMedCentralPubMedCrossRef
20.
Mattioli S, Ruffato A, Lugaresi M, Pilotti V, Aramini B, D’Ovidio F (2010) Long-term results of the Heller-Dor operation with intraoperative manometry for the treatment of esophageal achalasia. J Thorac Cardiovasc Surg 140:962–969PubMedCrossRef
21.
Endo S, Nakajima K, Nishikawa K, Takahashi T, Souma Y, Taniguchi E, Ito T, Nishida T (2009) Laparoscopic Heller-Dor surgery for esophageal achalasia: impact of intraoperative real-time manometric feedback on postoperative outcomes. Dig Surg 26:342–348PubMedCrossRef
22.
Chapman JR, Joehl RJ, Murayama KM, Tatum RP, Shi G, Hirano I, Jones MP, Pandolfino JE, Kahrilas PJ (2004) Achalasia treatment: improved outcome of laparoscopic myotomy with operative manometry. Arch Surg 139:508–513 discussion 13PubMedCrossRef
23.
Kilic A, Schuchert MJ, Pennathur A, Gilbert S, Landreneau RJ, Luketich JD (2009) Long-term outcomes of laparoscopic Heller myotomy for achalasia. Surgery 146:826–831 discussion 31-3PubMedCrossRef
Metadata
Title
Esophagogastric junction distensibility measurements during Heller myotomy and POEM for achalasia predict postoperative symptomatic outcomes
Authors
Ezra N. Teitelbaum
Nathaniel J. Soper
John E. Pandolfino
Peter J. Kahrilas
Ikuo Hirano
Lubomyr Boris
Frédéric Nicodème
Zhiyue Lin
Eric S. Hungness
Publication date
01-03-2015
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 3/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-014-3733-1

Other articles of this Issue 3/2015

Surgical Endoscopy 3/2015 Go to the issue

Technique

Laparoscopy in the diagnosis and repair of diaphragmatic injuries in left-sided penetrating thoracoabdominal trauma

OriginalPaper

Neuromuscular blockade improves surgical conditions (NISCO)

OriginalPaper

Technical description and feasibility of laparoscopic adrenal contouring using fluorescence imaging

Erratum

Erratum to: Comparative assessment of surgeons’ task performance and surgical ergonomics associated with conventional and modified flank positions: a simulation study

OriginalPaper

Surgical transgastric debridement of walled off pancreatic necrosis: an option for patients with necrotizing pancreatitis

Video

Laparoscopic redo paraesophageal hernia repair with collis gastroplasty for shortened esophagus