Alexander Abadir, MD1, Zain Moosvi, MD1, Vicky Cao1, Jason Samarasena, MD, FACG1, Kenneth J. Chang, MD, FACG2
1University of California Irvine Medical Center, Orange, CA; 2University of California Irvine, Orange, CA
Introduction: Peroral endoscopic myotomy (POEM) is a promising novel treatment modality for achalasia. Treatment success is usually determined by the patient's improvement in symptoms. A diagnostic tool during the POEM to evaluate effectiveness of the myotomy may aid in performing the POEM procedure optimally. One such diagnostic tool is the Endoluminal Functional Lumen Imaging Probe (FLIP), which uses impedance planimetry for real-time, intraoperative measurement of gastroesophageal junction diameter, compliance, distension, and surface area. Here we evaluate the efficacy of POEM using FLIP and compare changes in FLIP with those in Eckhardt scores.
Methods: This studied was performed at our tertiary care referral center. A total of 72 patients underwent POEM in this study. FLIP data was collected during the procedure with respect to the following variables: diameter, circumferential area, distention, and compliance. Eckhardt scores were assessed before and after POEM. Mean follow-up time was 2.96 months.
Results: Mean age was 57 years. 57% of patients were female. Mean diameter pre-POEM was 5.61 (SD = 2.20) mm and post-POEM was 10.57 (SD = 13.36 ) mm (n = 66). Mean circumferential area pre-POEM was 23.25 (SD = 10.67) mm2 and post-POEM was 61.89 (SD = 30.09) mm2 (n = 64). Mean distention pre-POEM was 1.31 (SD = 0.83) mm2/mmHg and post-POEM was 3.49 (SD = 1.85) mm2/mmHg (n =63). Mean compliance pre-POEM was 84.99 (SD-83.33) mm3/mmHg and post-POEM was 117.76 (SD=79.05) mm3/mmHg (n=59). All p values were less than 0.01. There was a negative correlation between the changes in all FLIP measurements and Eckhardt scores before and after POEM.
Discussion: This study is one of the largest on patients undergoing POEM examined with FLIP. FLIP measurements may serve as an intraprocedural measurement of POEM efficacy. The fact that a negative correlation between FLIP and Eckhardt scores was achieved indicates that FLIP may be a prognostic indicator for POEM patients, although further follow up data will be needed to establish this.
Citation: Alexander Abadir, MD; Zain Moosvi, MD; Vicky Cao; Jason Samarasena, MD, FACG; Kenneth J. Chang, MD, FACG. P0279 - MEASURING DIFFERENCES IN GEJ COMPLIANCE USING FUNCTIONAL LUMINAL IMPEDENCE PLANIMETRY (FLIP) IN A LARGE SERIES OF PATIENTS UNDERGOING POEM. Program No. P0279. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.