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Abstract：
BACKGROUND: Peroral endoscopic myotomy (POEM) is the standard treatment for achalasia. Functional luminal imaging probe (FLIP) technology enables objective measurement of lower esophageal sphincter (LES) geometry, with literature linking specific values to improved post-POEM outcomes. Our study assesses FLIP\'s intraoperative use in evaluating myotomy extent in real-time.
METHODS: Retrospective data from all patients undergoing POEM with intraoperative FLIP measurements were extracted from June 2020 to January 2023. The primary endpoint was intraoperative FLIP measurements, management changes, and symptom improvement (Eckardt score).
RESULTS: Fourteen patients (age 56 ± 14 years, BMI 28 ± 7 kg/m2) were identified. Most patients were female (64%). Predominantly, patients presented with type II achalasia (50%). FLIP measurements were taken before and after myotomy, demonstrating increases in mean distensibility index (DI) 1.6 ± 1. 4 to 5.4 ± 2.1 mm2/mmHg (p < 0.05) and mean diameter (Dmin) 6 ± 1.8 to 10.9 ± 2.3 mm (p < 0.05) at 50 ml balloon fill. Additional myotomy was performed in one patient when an inadequate increase in FLIP values were noted. Mean operative time was 98 ± 28 min, and there were no intraoperative complications. At the 30-day follow-up, median Eckardt score decreased from mean a preoperative score of 7 ± 2 to a post-operative mean of 2 ± 3, with 10 patients (78%) having a score ≤ 2. In total, four patients experienced symptom recurrence, with repeat FLIP values revealing a significant decrease in DI from 7 ± 2.2 post-POEM to 2.5 ± 1.5 at recurrence. FLIP technology identified LES pathology in 3 out of 4 (75%) patients, facilitating referral to LES-directed therapy.
CONCLUSIONS: Our study adds to the literature supporting the use of FLIP technology during the POEM procedure, with most patients achieving ideal values after a standard-length myotomy. This suggests the potential benefits of shorter myotomies guided by FLIP to achieve comparable outcomes and reduce postoperative GERD risk. Collaborative standardization of study designs and outcome measures is crucial for facilitating prospective trials and cross-setting outcome comparisons.
METHODS: Retrospective data from all patients undergoing POEM with intraoperative FLIP measurements were extracted from June 2020 to January 2023. The primary endpoint was intraoperative FLIP measurements, management changes, and symptom improvement (Eckardt score).
RESULTS: Fourteen patients (age 56 ± 14 years, BMI 28 ± 7 kg/m2) were identified. Most patients were female (64%). Predominantly, patients presented with type II achalasia (50%). FLIP measurements were taken before and after myotomy, demonstrating increases in mean distensibility index (DI) 1.6 ± 1. 4 to 5.4 ± 2.1 mm2/mmHg (p < 0.05) and mean diameter (Dmin) 6 ± 1.8 to 10.9 ± 2.3 mm (p < 0.05) at 50 ml balloon fill. Additional myotomy was performed in one patient when an inadequate increase in FLIP values were noted. Mean operative time was 98 ± 28 min, and there were no intraoperative complications. At the 30-day follow-up, median Eckardt score decreased from mean a preoperative score of 7 ± 2 to a post-operative mean of 2 ± 3, with 10 patients (78%) having a score ≤ 2. In total, four patients experienced symptom recurrence, with repeat FLIP values revealing a significant decrease in DI from 7 ± 2.2 post-POEM to 2.5 ± 1.5 at recurrence. FLIP technology identified LES pathology in 3 out of 4 (75%) patients, facilitating referral to LES-directed therapy.
CONCLUSIONS: Our study adds to the literature supporting the use of FLIP technology during the POEM procedure, with most patients achieving ideal values after a standard-length myotomy. This suggests the potential benefits of shorter myotomies guided by FLIP to achieve comparable outcomes and reduce postoperative GERD risk. Collaborative standardization of study designs and outcome measures is crucial for facilitating prospective trials and cross-setting outcome comparisons.
摘要：
背景：经口内镜下肌切开术（POEM）是贲门失弛缓症的标准治疗方法。功能性腔成像探头（FLIP）技术可实现食管下段括约肌（LES）几何形状的客观测量，文献将具体的价值与POEM后结果的改善联系起来。我们的研究评估了FLIP术中在实时评估肌切开术范围中的应用。
方法：从2020年6月至2023年1月提取所有接受POEM并进行术中FLIP测量的患者的回顾性数据。主要终点是术中FLIP测量，管理变革,和症状改善（Eckardt评分）。
结果：14例患者（年龄56±14岁，BMI28±7kg/m2）。大多数患者为女性（64%）。主要是,患者表现为II型贲门失弛缓症（50%）。在肌切开术之前和之后进行FLIP测量，显示平均扩张指数（DI）1.6±1增加。在50ml球囊填充时,4至5.4±2.1mm2/mmHg(p<0.05)和平均直径(Dmin)6±1.8至10.9±2.3mm(p<0.05)。当发现FLIP值增加不足时，对一名患者进行了额外的肌切开术。平均手术时间98±28分钟,术中无并发症。在30天的随访中，Eckardt评分中位数从术前平均7±2分降低至术后平均2±3分,其中10例患者(78%)的评分≤2分.总的来说,四名患者出现症状复发，重复FLIP值显示DI从POEM后的7±2.2显着降低至复发时的2.5±1.5。FLIP技术在4例患者中的3例（75％）中确定了LES病理，促进转诊至LES定向治疗。
结论：我们的研究增加了支持在POEM过程中使用FLIP技术的文献，大多数患者在标准长度肌切开术后达到理想值。这表明在FLIP指导下进行较短的肌切开术可以获得可比的结果并降低术后GERD风险。研究设计和结果测量的协作标准化对于促进前瞻性试验和交叉设置结果比较至关重要。
方法：从2020年6月至2023年1月提取所有接受POEM并进行术中FLIP测量的患者的回顾性数据。主要终点是术中FLIP测量，管理变革,和症状改善（Eckardt评分）。
结果：14例患者（年龄56±14岁，BMI28±7kg/m2）。大多数患者为女性（64%）。主要是,患者表现为II型贲门失弛缓症（50%）。在肌切开术之前和之后进行FLIP测量，显示平均扩张指数（DI）1.6±1增加。在50ml球囊填充时,4至5.4±2.1mm2/mmHg(p<0.05)和平均直径(Dmin)6±1.8至10.9±2.3mm(p<0.05)。当发现FLIP值增加不足时，对一名患者进行了额外的肌切开术。平均手术时间98±28分钟,术中无并发症。在30天的随访中，Eckardt评分中位数从术前平均7±2分降低至术后平均2±3分,其中10例患者(78%)的评分≤2分.总的来说,四名患者出现症状复发，重复FLIP值显示DI从POEM后的7±2.2显着降低至复发时的2.5±1.5。FLIP技术在4例患者中的3例（75％）中确定了LES病理，促进转诊至LES定向治疗。
结论：我们的研究增加了支持在POEM过程中使用FLIP技术的文献，大多数患者在标准长度肌切开术后达到理想值。这表明在FLIP指导下进行较短的肌切开术可以获得可比的结果并降低术后GERD风险。研究设计和结果测量的协作标准化对于促进前瞻性试验和交叉设置结果比较至关重要。
