Intraoperative FLIP distensibility during POEM varies according to achalasia subtype
Background The functional luminal imaging probe (FLIP) can be used to measure the esophagogastric junction distensibility index (DI) during myotomy for achalasia and increased DI has been shown to predict superior clinical outcomes. The objective of this study was to determine if the intraoperative...
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| Veröffentlicht in: | Surgical endoscopy 2021-06, Vol.35 (6), p.3097-3103 |
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| description | Background
The functional luminal imaging probe (FLIP) can be used to measure the esophagogastric junction distensibility index (DI) during myotomy for achalasia and increased DI has been shown to predict superior clinical outcomes. The objective of this study was to determine if the intraoperative DI and the changes produced by per oral endoscopic myotomy (POEM) differed between achalasia subtypes.
Methods
FLIP measurements were performed during POEM for achalasia at a single institution. DI (defined as the minimum cross-sectional area (CSA) at the EGJ divided by distensive pressure) was measured at three time points: after induction of anesthesia, after submucosal tunneling, and after myotomy. Measurements were reported at the 40 mL fill volume for the 8 cm FLIP (EF-325) and at the 60 mL fill volume for the 16 cm FLIP (EF-322). Measurements were compared using chi-square and Kruskal–Wallis tests.
Results
142 patients had intraoperative FLIP performed during POEM for achalasia between 2012 and 2019 (30 type I, 68 type II, 27 type III, and 17 variant). Patients with type I achalasia had a significantly higher induction DI (median 1.7 mm
2
/mmHg) than type II (0.8 mm
2
/mmHg), type III (0.9 mm
2
/mmHg), and variants (1.1 mm
2
/mmHg;
p
|
| doi_str_mv | 10.1007/s00464-020-07740-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2419098997</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2525898620</sourcerecordid><originalsourceid>FETCH-LOGICAL-c441t-1373bcd61e88d820a7ec1e4d8d838dac7546de3335f2f16c2ef6e14f21d0aa523</originalsourceid><addsrcrecordid>eNp9kEtLxDAQx4Mouj6-gAcpePFSnTzaNEcRHwsretBzyCZTjXTbmrTC-unNuj7Ag6dhht_8Z_gRckjhlALIswggSpEDgxykFJC_b5AJFZzljNFqk0xAcciZVGKH7Mb4AolXtNgmO5yVQGWhJuRh2g7BdD0GM_g3zK5m0_vM-ThgG_3cN35YZm4Mvn3K7u8ub7M3EzzGzFjbBbeaDl1qnk1jojdZHOfDssd9slWbJuLBV90jj1eXDxc3-ezuenpxPsutEHTIKZd8bl1JsapcxcBItBSFSw2vnLGyEKVDznlRs5qWlmFdIhU1ow6MKRjfIyfr3D50ryPGQS98tNg0psVujJoJqkBVSsmEHv9BX7oxtOk7zQpWVKoqGSSKrSkbuhgD1roPfmHCUlPQK-d67Vwn5_rTuX5PS0df0eN8ge5n5VtyAvgaiP1KJIbf2__EfgB_OozP</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2525898620</pqid></control><display><type>article</type><title>Intraoperative FLIP distensibility during POEM varies according to achalasia subtype</title><source>SpringerLink Journals - AutoHoldings</source><creator>Holmstrom, Amy L. ; Campagna, Ryan A. J. ; Alhalel, Jonathan ; Carlson, Dustin A. ; Pandolfino, John E. ; Hungness, Eric S. ; Teitelbaum, Ezra N.</creator><creatorcontrib>Holmstrom, Amy L. ; Campagna, Ryan A. J. ; Alhalel, Jonathan ; Carlson, Dustin A. ; Pandolfino, John E. ; Hungness, Eric S. ; Teitelbaum, Ezra N.</creatorcontrib><description>Background
The functional luminal imaging probe (FLIP) can be used to measure the esophagogastric junction distensibility index (DI) during myotomy for achalasia and increased DI has been shown to predict superior clinical outcomes. The objective of this study was to determine if the intraoperative DI and the changes produced by per oral endoscopic myotomy (POEM) differed between achalasia subtypes.
Methods
FLIP measurements were performed during POEM for achalasia at a single institution. DI (defined as the minimum cross-sectional area (CSA) at the EGJ divided by distensive pressure) was measured at three time points: after induction of anesthesia, after submucosal tunneling, and after myotomy. Measurements were reported at the 40 mL fill volume for the 8 cm FLIP (EF-325) and at the 60 mL fill volume for the 16 cm FLIP (EF-322). Measurements were compared using chi-square and Kruskal–Wallis tests.
Results
142 patients had intraoperative FLIP performed during POEM for achalasia between 2012 and 2019 (30 type I, 68 type II, 27 type III, and 17 variant). Patients with type I achalasia had a significantly higher induction DI (median 1.7 mm
2
/mmHg) than type II (0.8 mm
2
/mmHg), type III (0.9 mm
2
/mmHg), and variants (1.1 mm
2
/mmHg;
p
< 0.001). These differences persisted after submucosal tunneling and final DI after myotomy was also significantly higher in type I patients (median 8.0 mm
2
/mmHg) compared to type II (5.8 mm
2
/mmHg), type III (3.9 mm
2
/mmHg), and variants (5.4 mm
2
/mmHg;
p
< 0.001). Achalasia subtypes were found to have similar CSA at all time points, whereas pressure differed with type I having the lowest pressure and type III the highest.
Conclusion
The DI at each operative step during POEM was found to differ significantly between achalasia subtypes. These differences in DI were due to pressure, as CSA was similar between subtypes. Achalasia subtype should be accounted for when using FLIP as an intraoperative calibration tool and in future studies examining the relationship between DI and clinical outcomes.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-020-07740-z</identifier><identifier>PMID: 32601759</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>2020 SAGES Oral ; Abdominal Surgery ; Catheters ; Clinical outcomes ; Endoscopy ; Esophagus ; Gastroenterology ; Gynecology ; Hepatology ; Laparoscopy ; Medicine ; Medicine & Public Health ; Motility ; Patients ; Pressure transducers ; Proctology ; Surgery</subject><ispartof>Surgical endoscopy, 2021-06, Vol.35 (6), p.3097-3103</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020</rights><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c441t-1373bcd61e88d820a7ec1e4d8d838dac7546de3335f2f16c2ef6e14f21d0aa523</citedby><cites>FETCH-LOGICAL-c441t-1373bcd61e88d820a7ec1e4d8d838dac7546de3335f2f16c2ef6e14f21d0aa523</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-020-07740-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-020-07740-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32601759$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Holmstrom, Amy L.</creatorcontrib><creatorcontrib>Campagna, Ryan A. J.</creatorcontrib><creatorcontrib>Alhalel, Jonathan</creatorcontrib><creatorcontrib>Carlson, Dustin A.</creatorcontrib><creatorcontrib>Pandolfino, John E.</creatorcontrib><creatorcontrib>Hungness, Eric S.</creatorcontrib><creatorcontrib>Teitelbaum, Ezra N.</creatorcontrib><title>Intraoperative FLIP distensibility during POEM varies according to achalasia subtype</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
The functional luminal imaging probe (FLIP) can be used to measure the esophagogastric junction distensibility index (DI) during myotomy for achalasia and increased DI has been shown to predict superior clinical outcomes. The objective of this study was to determine if the intraoperative DI and the changes produced by per oral endoscopic myotomy (POEM) differed between achalasia subtypes.
Methods
FLIP measurements were performed during POEM for achalasia at a single institution. DI (defined as the minimum cross-sectional area (CSA) at the EGJ divided by distensive pressure) was measured at three time points: after induction of anesthesia, after submucosal tunneling, and after myotomy. Measurements were reported at the 40 mL fill volume for the 8 cm FLIP (EF-325) and at the 60 mL fill volume for the 16 cm FLIP (EF-322). Measurements were compared using chi-square and Kruskal–Wallis tests.
Results
142 patients had intraoperative FLIP performed during POEM for achalasia between 2012 and 2019 (30 type I, 68 type II, 27 type III, and 17 variant). Patients with type I achalasia had a significantly higher induction DI (median 1.7 mm
2
/mmHg) than type II (0.8 mm
2
/mmHg), type III (0.9 mm
2
/mmHg), and variants (1.1 mm
2
/mmHg;
p
< 0.001). These differences persisted after submucosal tunneling and final DI after myotomy was also significantly higher in type I patients (median 8.0 mm
2
/mmHg) compared to type II (5.8 mm
2
/mmHg), type III (3.9 mm
2
/mmHg), and variants (5.4 mm
2
/mmHg;
p
< 0.001). Achalasia subtypes were found to have similar CSA at all time points, whereas pressure differed with type I having the lowest pressure and type III the highest.
Conclusion
The DI at each operative step during POEM was found to differ significantly between achalasia subtypes. These differences in DI were due to pressure, as CSA was similar between subtypes. Achalasia subtype should be accounted for when using FLIP as an intraoperative calibration tool and in future studies examining the relationship between DI and clinical outcomes.</description><subject>2020 SAGES Oral</subject><subject>Abdominal Surgery</subject><subject>Catheters</subject><subject>Clinical outcomes</subject><subject>Endoscopy</subject><subject>Esophagus</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Laparoscopy</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Motility</subject><subject>Patients</subject><subject>Pressure transducers</subject><subject>Proctology</subject><subject>Surgery</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kEtLxDAQx4Mouj6-gAcpePFSnTzaNEcRHwsretBzyCZTjXTbmrTC-unNuj7Ag6dhht_8Z_gRckjhlALIswggSpEDgxykFJC_b5AJFZzljNFqk0xAcciZVGKH7Mb4AolXtNgmO5yVQGWhJuRh2g7BdD0GM_g3zK5m0_vM-ThgG_3cN35YZm4Mvn3K7u8ub7M3EzzGzFjbBbeaDl1qnk1jojdZHOfDssd9slWbJuLBV90jj1eXDxc3-ezuenpxPsutEHTIKZd8bl1JsapcxcBItBSFSw2vnLGyEKVDznlRs5qWlmFdIhU1ow6MKRjfIyfr3D50ryPGQS98tNg0psVujJoJqkBVSsmEHv9BX7oxtOk7zQpWVKoqGSSKrSkbuhgD1roPfmHCUlPQK-d67Vwn5_rTuX5PS0df0eN8ge5n5VtyAvgaiP1KJIbf2__EfgB_OozP</recordid><startdate>20210601</startdate><enddate>20210601</enddate><creator>Holmstrom, Amy L.</creator><creator>Campagna, Ryan A. J.</creator><creator>Alhalel, Jonathan</creator><creator>Carlson, Dustin A.</creator><creator>Pandolfino, John E.</creator><creator>Hungness, Eric S.</creator><creator>Teitelbaum, Ezra N.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20210601</creationdate><title>Intraoperative FLIP distensibility during POEM varies according to achalasia subtype</title><author>Holmstrom, Amy L. ; Campagna, Ryan A. J. ; Alhalel, Jonathan ; Carlson, Dustin A. ; Pandolfino, John E. ; Hungness, Eric S. ; Teitelbaum, Ezra N.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c441t-1373bcd61e88d820a7ec1e4d8d838dac7546de3335f2f16c2ef6e14f21d0aa523</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>2020 SAGES Oral</topic><topic>Abdominal Surgery</topic><topic>Catheters</topic><topic>Clinical outcomes</topic><topic>Endoscopy</topic><topic>Esophagus</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Laparoscopy</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Motility</topic><topic>Patients</topic><topic>Pressure transducers</topic><topic>Proctology</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Holmstrom, Amy L.</creatorcontrib><creatorcontrib>Campagna, Ryan A. J.</creatorcontrib><creatorcontrib>Alhalel, Jonathan</creatorcontrib><creatorcontrib>Carlson, Dustin A.</creatorcontrib><creatorcontrib>Pandolfino, John E.</creatorcontrib><creatorcontrib>Hungness, Eric S.</creatorcontrib><creatorcontrib>Teitelbaum, Ezra N.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Holmstrom, Amy L.</au><au>Campagna, Ryan A. J.</au><au>Alhalel, Jonathan</au><au>Carlson, Dustin A.</au><au>Pandolfino, John E.</au><au>Hungness, Eric S.</au><au>Teitelbaum, Ezra N.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intraoperative FLIP distensibility during POEM varies according to achalasia subtype</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2021-06-01</date><risdate>2021</risdate><volume>35</volume><issue>6</issue><spage>3097</spage><epage>3103</epage><pages>3097-3103</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
The functional luminal imaging probe (FLIP) can be used to measure the esophagogastric junction distensibility index (DI) during myotomy for achalasia and increased DI has been shown to predict superior clinical outcomes. The objective of this study was to determine if the intraoperative DI and the changes produced by per oral endoscopic myotomy (POEM) differed between achalasia subtypes.
Methods
FLIP measurements were performed during POEM for achalasia at a single institution. DI (defined as the minimum cross-sectional area (CSA) at the EGJ divided by distensive pressure) was measured at three time points: after induction of anesthesia, after submucosal tunneling, and after myotomy. Measurements were reported at the 40 mL fill volume for the 8 cm FLIP (EF-325) and at the 60 mL fill volume for the 16 cm FLIP (EF-322). Measurements were compared using chi-square and Kruskal–Wallis tests.
Results
142 patients had intraoperative FLIP performed during POEM for achalasia between 2012 and 2019 (30 type I, 68 type II, 27 type III, and 17 variant). Patients with type I achalasia had a significantly higher induction DI (median 1.7 mm
2
/mmHg) than type II (0.8 mm
2
/mmHg), type III (0.9 mm
2
/mmHg), and variants (1.1 mm
2
/mmHg;
p
< 0.001). These differences persisted after submucosal tunneling and final DI after myotomy was also significantly higher in type I patients (median 8.0 mm
2
/mmHg) compared to type II (5.8 mm
2
/mmHg), type III (3.9 mm
2
/mmHg), and variants (5.4 mm
2
/mmHg;
p
< 0.001). Achalasia subtypes were found to have similar CSA at all time points, whereas pressure differed with type I having the lowest pressure and type III the highest.
Conclusion
The DI at each operative step during POEM was found to differ significantly between achalasia subtypes. These differences in DI were due to pressure, as CSA was similar between subtypes. Achalasia subtype should be accounted for when using FLIP as an intraoperative calibration tool and in future studies examining the relationship between DI and clinical outcomes.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>32601759</pmid><doi>10.1007/s00464-020-07740-z</doi><tpages>7</tpages></addata></record> |
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| source | SpringerLink Journals - AutoHoldings |
| subjects | 2020 SAGES Oral Abdominal Surgery Catheters Clinical outcomes Endoscopy Esophagus Gastroenterology Gynecology Hepatology Laparoscopy Medicine Medicine & Public Health Motility Patients Pressure transducers Proctology Surgery |
| title | Intraoperative FLIP distensibility during POEM varies according to achalasia subtype |
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