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Ashley E. Williams*, Matthew Kutcher, James B. Littlejohn, Jacob R. Moremen
Surgery, University of Mississippi Medical Center, Jackson, MS

Background and Aims: Gastric peroral myotomy (G-POP) is an emerging minimally invasive endoscopic technique for the treatment of refractory gastroparesis. Functional luminal imaging probe (FLIP) is an endoscopic tool that measures the physiologic characteristics of GI sphincters. In this study, we used FLIP to evaluate the association between the pyloric physiologic measurements and the clinical outcomes of G-POP in patients with refractory gastroparesis.

Methods: Twenty patients underwent G-POP for management of refractory gastroparesis with pre- and post-POP FLIP measurements evaluated. Cross-sectional area (CSA), diameter (Dmin), and the distensibility index (DI) of the pylorus were evaluated at 40 mL and 50 mL balloon fills. Patient outcomes (PRO) reported as Gastroparesis Cardinal Symptom Index (GCSI) were obtained at 6 week clinical follow-up when available or by phone survey and compared with the EndoFLIP measurements.

Results: Technical success was achieved in all patients. Of 18 patients with follow-up available, 89% (16 of 18) patients reported subjective improvement; of 14 patients with pre- and post-operative GCSI data, mean symptom score improved from 16.2 +/- 4.0 to 10.1 +/- 7.8 (p=0.002). In terms of FLIP measurements, at 50mL balloon fill volume CSA increased by 44.1 +/- 54.4 mm2 (p=0.006), DI increased by 1.4 +/- 1.0 mm2/mmHg (p<0.001), and minimum diameter increased by 1.6 +/- 1.8 mm (p=0.003). Types of gastroparesis included idiopathic (15), diabetic (5), post-procedural (3), and were not statistically significant variables. Mean body mass index was higher (37.8 vs. 27.0 kg/m2, p=0.032), but age, sex, and preoperative GCSI did not differ between patients who did not have improved GCSI postoperatively compared to those with symptomatic improvement. No FLIP measurements were significantly correlated with self-reported symptom improvement.

Conclusions: Pyloric CSA, DI, and Dmin all increase following G-POP, with a high rate (89%) of patient reported clinical success at 6 week follow-up. FLIP measurements of the pylorus have the potential to be used as a tool to predict the clinical outcome of G-POP.

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