INTRAOPERATIVE IMPEDANCE PLANIMETREY AND PANOMETRY CAN REPLACE MANOMETRY IN PREOPERATIVE GASTROESOPHAGEAL REFLUX ASSESSMENT
Vanessa N. VanDruff*, Julia R. Amundson, Hoover Wu, Michelle Campbell, Kristine Kuchta, Herbert M. Hedberg, Michael Ujiki
NorthShore University HealthSystem, Evanston, IL
Endoluminal functional impedance planimetry and panometry is an advanced technology able to assess esophageal motility by measurement of secondary peristalsis to volumetric distention under sedation. The ability to assess peristaltic function during endoscopy or operative procedure may prove invaluable for gastrointestinal surgeons as patients are evaluated comfortably and efficiently. Currently, there is a paucity of literature regarding intraoperative panometry and its association with primary peristaltic function assessed by high-resolution manometry (HRM).
Prospective data from a single institution was collected intraoperatively from 30 patients with gastroesophageal reflux disease (GERD) undergoing laparoscopic fundoplication between August and November of 2021. A 16cm functional luminal imaging probe (FLIP) was utilized to assess planimetry and panometry prior to fundoplication under general anesthesia at the start of each case. The probe was placed 2 impedance planimetry channels below the lower gastroesophageal sphincter, inflated to 40mL for 60 seconds, and then incrementally inflated by 10mL every 30 seconds until 70mL maximum fill. During stepwise inflation, panometry was recorded and esophageal contractile response was classified as normal (NCR), diminished or disordered (DDCR), or absent (ACR) in real-time by a single panometry rater, blinded to preoperative HRM results. Functional luminal imaging results were then compared postoperatively to preoperative HRM results.
Data was collected from 30 patients, 25 females and 5 males, with mean 63±15 years of age. Fifteen patients (50%) had peristaltic dysfunction on HRM. All 15 patients with dysfunction on HRM were correctly identified by intraoperative panometry as abnormal (13 patients with DDCR, 2 patients with ACR) resulting in a 100% sensitivity rate. All 10 patients with normal motility on panometry had normal peristaltic function on HRM, resulting in a 100% negative predictive value. Five patients with normal HRM, had abnormal DDCR on panometry. These patients were notable for paraesophageal hernias with larger hernia lengths (8.3±1cm vs. 3.6±4.1cm, p= 0.053).
Impedance planimetry and panometry can assess esophageal motility under general anesthesia and accurately detect peristaltic dysfunction in patients with GERD. Panometry is a novel tool that has the potential to streamline and improve patient care, and therefore should be considered as an alternative to HRM, especially in patients in which HRM would be inaccessible or poorly tolerated. Panometry may not be reliable in patients with large paraesophageal hernias and should not replace HRM when evaluating for dysmotility.
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