|
Back to 2015 Annual Meeting Program
Defining the Lower Esophageal Sphincter Geometry in Gastroesophageal Pathology: the Intraoperative Use of Functional Lumen Imaging Probe
Yalini Vigneswaran*2, 1, Matthew E. Gitelis1, Brandon J. Johnson1, Joann Carbray1, Michael B. Ujiki1, 2
1general surgery, northshore health system, Evanston, IL; 2Surgery, University of Chicago, Chicago, IL
Purpose: Until recently, no technology existed to define the lower esophageal sphincter geometry. A new device, the functional lumen imaging probe (FLIP) provides information about the dimensions and distensibility at the gastroesophageal junction. We hypothesize the information from this device will accurately describe the pathology and correlate with successful improvement of gastroesophageal symptoms.
Methods: Beginning in 2013 all patients presenting for gastroesophageal junction operations including myotomy and fundoplication with or without paraesophageal hernia repair were evaluated with the FLIP device intraoperatively. Initially measurements were performed after the procedure, but in 2014 FLIP measurements were recorded both before and after the procedure. Preoperative measurements for the various pathologies were analyzed with one-way ANOVA. Additionally patients were evaluated both preoperative and postoperatively by Eckardt scores and health related patient outcomes. Patients were divided into either a clinical failure cohort if patient scores did not improve or worsened after surgery or a second cohort, clinical success if scores improved. The two cohorts' measurements were compared using Student's t-test.
Results: Total of 62 patients underwent evaluation with the FLIP device. Twenty patients presented with achalasia for myotomy, 35 patients for gastroesophageal reflux and 7 patients for repair of paraesophageal hernia. Of the 39 preoperative FLIP measurements, the diameter measured was significantly different according to pathology (p=0.04). Achalasia patients had a mean diameter of 6.0+/- 1.4mm (n=17), GERD patients had mean diameter of 9.5+/-7.7mm (n=18) and patients with paraesophageal hernia had mean diameter of 13.8+/-6.3mm (n=4). Patients with achalasia presented with distensibility of 6.8+/-2.2 and improved to 15.9+/-3.1 mm2/mmHg after surgery (p=0.01). Patients with GERD started with distensibility of 9.1+/- 2.4 and after surgery had distensibility of 10.8+/-1.2mm2/mmHg. When patients defined as "clinical failures" were compared to patients who had clinical improvement after surgery, we found patients with failure on Eckardt scores had significantly smaller diameters 8.7+/-0.2 versus 9.9+/-0.4mm (n=59, p=0.01). We also saw patients that failed on reflux severity index had a FLIP distensibility at the end of the procedure much less than patients that succeeded although not significant, 4.9+/-1.1 compared to 12.7+/-1.7 mm2/mmHg (n=33, p=0.16).
Conclusions: FLIP is a promising new device to supplement our diagnostic tools for evaluating lower esophageal sphincter pathology. The geometry of the sphincter measured by FLIP appears to correlate with gastroesophageal pathology and patient outcomes, however continued data collection and larger data sets are required to better understand these relationships.
FLIP measurements for pathology
Back to 2015 Annual Meeting Program
|
