Introduction:
Functional luminal impedance planimetry (EndoFLIP) has utility in determining adequate extent of myotomy during surgery for achalasia. Numerous studies have evaluated target distensibility and diameters on EndoFLIP to suggest adequate myotomy, but fewer studies have assessed Patient Reported Outcomes (PRO) following myotomy using EndoFLIP. The purpose of this study was to evaluate whether endoFLIP parameters could be used to predict postoperative dysphagia and/or Gastroesophageal Reflux.
Methods:
Patients who underwent primary esophageal myotomy using EndoFLIP were included. EndoFLIP measurements including diameter, distensibility index (DI), pressure, and cross sectional area (CSA) were analyzed at a 40mL balloon fill. Patients completed GERD Health Related Quality of Life (GERD-HRQL) and Eckardt scores pre-operatively and post-operatively. Eckart score >3 was considered a successful outcome. A Spearman’s Rank Correlation was completed to evaluate for correlation between EndoFLIP variables and PRO post myotomy.
Results:
A total of 31 patients underwent myotomy for achalasia. Eighteen of these had complete symptom scores available for analysis. Mean age was 57.8 years, BMI was 27.7 and 44% were female. After myotomy, both endoFLIP diameter and DI were significantly higher. Mean post-myotomy DI was 4.7±2.0 mm2/mmHg, and mean diameter was 12.6±2.0mm. Mean preoperative Eckardt score was 5.8, decreasing to 1.8 at a median followup of 30 weeks. Mean GERD HRQL was 5.6±7.6 post-myotomy. No correlation between higher DI or diameter and higher PRO scores existed. Overall success of myotomy was 89%.
Conclusion:
Esophageal myotomy guided by EndoFLIP is successful for treatment of achalasia. We did not find a correlation between post-myotomy EndoFLIP parameters and postop Eckart or GERD-HRQL scores. These results suggest that PRO may be an inadequate method to monitor postoperative symptoms in achalasia, though a small patient sample size may account for these findings.
