Background and Aims
Outcomes after peroral endoscopic myotomy (POEM) are assessed clinically by the Eckardt
score (ES) or objectively by high-resolution manometry (HRM) and functional lumen
imaging probe (FLIP). This study compared HRM and FLIP to evaluate clinical response
after POEM.
Methods
This was a single tertiary center retrospective study of consecutive patients who
underwent POEM for treatment-naive achalasia and with ≥6 months of follow-up. Baseline
and follow-up testing in all patients included ES, HRM, and FLIP of the esophagogastric
junction (EGJ). A normal post-POEM (or normalized) EGJ distensibility index (EGJ-DI)
>2.8 mm2/mm Hg, maximum EGJ diameter (MxEGJD) ≥14 mm, and integrated relaxation pressure (IRP) <15 mm
Hg were compared with a clinical response, defined as ES ≤3.
Results
Eighty-seven patients (58% men, mean age 51 ± 17 years) were included. Overall clinical
response by ES, IRP, MxEGJD, and EGJ-DI were 97.7%, 86.2%, 75.9%, and 92.0%, respectively.
The sensitivity of a normal IRP (87.1% [95% confidence interval {CI}, 78.0-93.4])
was similar to the sensitivity of a normal MxEGJD (75.3% [95% CI, 64.7-84.0], P = .053) and normal EGJ-DI (91.8% [95% CI, 83.8%-96.6%], P = .39) after POEM to predict clinical response. However, the sensitivity of a normal
post-POEM EGJ-DI was superior to a normal post-POEM MxEGJD (P = .001) to predict clinical response. There was no difference in the area under the
curve of a normal MxEGJD or EGJ-DI to predict a normal IRP (P = .956) after POEM.
Conclusions
Normal FLIP metrics ≥6 months after POEM for achalasia show good to excellent sensitivity
but are equivalent to a normalized IRP by HRM to predict clinical response by ESs.
FLIP may be used as an alternative to HRM to assess lower esophageal sphincter response
to POEM in these patients. (Clinical trial registration number: NCT02770859.)
Graphical abstract
Graphical Abstract
Abbreviations:
AUC (area under the curve), EGJ (esophagogastric junction), EGJ-DI (esophagogastric junction distensibility index), ES (Eckardt score), FLIP (functional lumen imaging probe), HRM (high-resolution manometry), IRP (integrated relaxation pressure), LES (lower esophageal sphincter), MxEGJD (maximum esophagogastric junction diameter), POEM (peroral endoscopic myotomy)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: December 31, 2021
Accepted:
December 29,
2021
Received:
September 19,
2021
Footnotes
DISCLOSURE: The following authors disclosed financial relationships: J. DeWitt: Consultant for Boston Scientific; grant support from Vyaire Medical, Inc. M. Al-Haddad: Consultant for Boston Scientific; grant support from Amplified Sciences and Cook Endoscopy. All other authors disclosed no financial relationships.
If you would like to chat with an author of this article, you may contact Dr DeWitt at [email protected] .
See CME section, p. 1001.
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