Assessment of Clinical Outcomes after Peroral Endoscopic Myotomy via Esophageal Distensibility Measu
Assessment of Clinical Outcomes after Peroral Endoscopic Myotomy via Esophageal Distensibility Measurements with the Endoluminal Functional Lumen Imaging Probe.
InKyung Yoo, Sang Ah Choi, Won Hee Kim, Sung Pyo Hong, Ozlem Ozer Cakir, Joo Young Cho. Gut and Liver, Vol. 13, No. 1, January 2019, pp. 32-39
Yoo et al evaluated the effectiveness of impedance planimetry (Endoflip) in predicting good clinical response (Eckard<3) after peroral endoscopic myotomy (POEM) in patients with achalasia. This was a retrospective study conducted between Nov 2014- Nov 2017 in 52 patients, with mean clinical follow-up of 288 days. The measure of lower esophageal sphincter (LES) distensibility during controlled volumetric distension of 30 or 40 ml of saline was performed one month post POEM. Multivariate analysis showed that a DI >7 was the best predictor of good clinical response (p 0.004). On the other hand, a correlation was observed between DI>10 and the presence of gastro-oesophageal reflux. In conclusion, the authors suggest, taking into account the weaknesses of the study (retrospective, low number of patients, mean follow-up of 288 days), that an IQ between 7 -10 would be ideal for good clinical response without greatly increasing the risk of reflux.
"Establishing the ideal post-POEM DI value will allow us to measure the DI immediately after the myotomy and see if the myotomy is complete, before making the tunnel closure. Possibly in the future this could decrease the rate of therapeutic failure and the need for a POEM redo", Hannah Pitanga, MD specialist at IECED.