Intraoperative diagnosis and treatment of Achalasia using EndoFLIP during Heller Myotomy and Dor fundoplication

Yi Ying Law; Duc T. Nguyen; Leonora M. Meisenbach; Ray K. Chihara; Edward Y. Chan; Edward A. Graviss; Min P. Kim

doi:10.1007/s00464-021-08517-8

Intraoperative diagnosis and treatment of Achalasia using EndoFLIP during Heller Myotomy and Dor fundoplication

Yi Ying Law, Duc T. Nguyen, Leonora M. Meisenbach, Ray K. Chihara, Edward Y. Chan, Edward A. Graviss, Min P. Kim

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

BACKGROUND: Manometry is the gold standard diagnostic test for achalasia. However, there are incidences where manometry cannot be obtained preoperatively, or the results of manometry is inconsistent with the patient's symptomatology. We aim to determine if intraoperative use of EndoFLIP can provide a diagnosis of achalasia and provide objective information during Heller myotomy and Dor fundoplication.

METHODS: To determine the intraoperative diagnostic EndoFLIP values for patients with achalasia, we determined the optimal cut-off points of the distensibility index (DI) between patients with a diagnosis of achalasia and patients with a diagnosis of hiatal hernia. To evaluate the usefulness of EndoFLIP values during Heller myotomy and Dor fundoplication, we obtained a cohort of patients with EndoFLIP values obtained after Heller myotomy and after Dor fundoplication as well as Eckardt score before and after surgery.

RESULTS: Our analysis of 169 patients (133 hiatal hernia and 36 achalasia) showed that patients with DI < 0.8 have a >99% probability of having achalasia, while DI > 2.3 have a >99% probability of having hiatal hernia. Patients with a DI 0.8-1.3 have a 95% probability of having achalasia, and patients with a DI of 1.4-2.2 have a 94% probability of having a hiatal hernia. There were 40 patients in the cohort to determine objective data during Heller myotomy and Dor fundoplication. The DI increased from a median of 0.7 to 3.2 after myotomy and decreased to 2.2 after Dor fundoplication (p < 0.001). The median Eckardt score went down from a median of 4.5 to 0 (p < 0.001).

CONCLUSIONS: Our study shows that intraoperative use of EndoFLIP can facilitate the diagnosis of achalasia and is used as an adjunct to diagnose achalasia when symptoms are inconsistent. The routine use of EndoFLIP during Heller myotomy and Dor fundoplication provides objective data during the operation in a group of patients with excellent short-term outcomes.

Original language	English (US)
Pages (from-to)	2365-2372
Number of pages	8
Journal	Surgical Endoscopy
Volume	36
Issue number	4
DOIs	https://doi.org/10.1007/s00464-021-08517-8
State	Published - Apr 2022

Keywords

Achalasia
Distensibility index
Dor fundoplication
Dysphagia
EndoFLIP
Endoluminal functional lumen imaging probe
Heller myotomy
Hiatal hernia
Humans
Laparoscopy/methods
Treatment Outcome
Esophageal Achalasia/diagnosis
Heller Myotomy
Fundoplication/methods
Hernia, Hiatal/diagnosis

ASJC Scopus subject areas

Surgery

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10.1007/s00464-021-08517-8

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@article{fa8fd1ab340e443581b4f0fb9c862a99,

title = "Intraoperative diagnosis and treatment of Achalasia using EndoFLIP during Heller Myotomy and Dor fundoplication",

abstract = "BACKGROUND: Manometry is the gold standard diagnostic test for achalasia. However, there are incidences where manometry cannot be obtained preoperatively, or the results of manometry is inconsistent with the patient's symptomatology. We aim to determine if intraoperative use of EndoFLIP can provide a diagnosis of achalasia and provide objective information during Heller myotomy and Dor fundoplication.METHODS: To determine the intraoperative diagnostic EndoFLIP values for patients with achalasia, we determined the optimal cut-off points of the distensibility index (DI) between patients with a diagnosis of achalasia and patients with a diagnosis of hiatal hernia. To evaluate the usefulness of EndoFLIP values during Heller myotomy and Dor fundoplication, we obtained a cohort of patients with EndoFLIP values obtained after Heller myotomy and after Dor fundoplication as well as Eckardt score before and after surgery.RESULTS: Our analysis of 169 patients (133 hiatal hernia and 36 achalasia) showed that patients with DI < 0.8 have a >99% probability of having achalasia, while DI > 2.3 have a >99% probability of having hiatal hernia. Patients with a DI 0.8-1.3 have a 95% probability of having achalasia, and patients with a DI of 1.4-2.2 have a 94% probability of having a hiatal hernia. There were 40 patients in the cohort to determine objective data during Heller myotomy and Dor fundoplication. The DI increased from a median of 0.7 to 3.2 after myotomy and decreased to 2.2 after Dor fundoplication (p < 0.001). The median Eckardt score went down from a median of 4.5 to 0 (p < 0.001).CONCLUSIONS: Our study shows that intraoperative use of EndoFLIP can facilitate the diagnosis of achalasia and is used as an adjunct to diagnose achalasia when symptoms are inconsistent. The routine use of EndoFLIP during Heller myotomy and Dor fundoplication provides objective data during the operation in a group of patients with excellent short-term outcomes.",

keywords = "Achalasia, Distensibility index, Dor fundoplication, Dysphagia, EndoFLIP, Endoluminal functional lumen imaging probe, Heller myotomy, Hiatal hernia, Humans, Laparoscopy/methods, Treatment Outcome, Esophageal Achalasia/diagnosis, Heller Myotomy, Fundoplication/methods, Hernia, Hiatal/diagnosis",

author = "Law, {Yi Ying} and Nguyen, {Duc T.} and Meisenbach, {Leonora M.} and Chihara, {Ray K.} and Chan, {Edward Y.} and Graviss, {Edward A.} and Kim, {Min P.}",

note = "{\textcopyright} 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.",

year = "2022",

month = apr,

doi = "10.1007/s00464-021-08517-8",

language = "English (US)",

volume = "36",

pages = "2365--2372",

journal = "Surgical Endoscopy",

issn = "0930-2794",

publisher = "Springer New York",

number = "4",

}

TY - JOUR

T1 - Intraoperative diagnosis and treatment of Achalasia using EndoFLIP during Heller Myotomy and Dor fundoplication

AU - Law, Yi Ying

AU - Nguyen, Duc T.

AU - Meisenbach, Leonora M.

AU - Chihara, Ray K.

AU - Chan, Edward Y.

AU - Graviss, Edward A.

AU - Kim, Min P.

PY - 2022/4

Y1 - 2022/4

N2 - BACKGROUND: Manometry is the gold standard diagnostic test for achalasia. However, there are incidences where manometry cannot be obtained preoperatively, or the results of manometry is inconsistent with the patient's symptomatology. We aim to determine if intraoperative use of EndoFLIP can provide a diagnosis of achalasia and provide objective information during Heller myotomy and Dor fundoplication.METHODS: To determine the intraoperative diagnostic EndoFLIP values for patients with achalasia, we determined the optimal cut-off points of the distensibility index (DI) between patients with a diagnosis of achalasia and patients with a diagnosis of hiatal hernia. To evaluate the usefulness of EndoFLIP values during Heller myotomy and Dor fundoplication, we obtained a cohort of patients with EndoFLIP values obtained after Heller myotomy and after Dor fundoplication as well as Eckardt score before and after surgery.RESULTS: Our analysis of 169 patients (133 hiatal hernia and 36 achalasia) showed that patients with DI < 0.8 have a >99% probability of having achalasia, while DI > 2.3 have a >99% probability of having hiatal hernia. Patients with a DI 0.8-1.3 have a 95% probability of having achalasia, and patients with a DI of 1.4-2.2 have a 94% probability of having a hiatal hernia. There were 40 patients in the cohort to determine objective data during Heller myotomy and Dor fundoplication. The DI increased from a median of 0.7 to 3.2 after myotomy and decreased to 2.2 after Dor fundoplication (p < 0.001). The median Eckardt score went down from a median of 4.5 to 0 (p < 0.001).CONCLUSIONS: Our study shows that intraoperative use of EndoFLIP can facilitate the diagnosis of achalasia and is used as an adjunct to diagnose achalasia when symptoms are inconsistent. The routine use of EndoFLIP during Heller myotomy and Dor fundoplication provides objective data during the operation in a group of patients with excellent short-term outcomes.

AB - BACKGROUND: Manometry is the gold standard diagnostic test for achalasia. However, there are incidences where manometry cannot be obtained preoperatively, or the results of manometry is inconsistent with the patient's symptomatology. We aim to determine if intraoperative use of EndoFLIP can provide a diagnosis of achalasia and provide objective information during Heller myotomy and Dor fundoplication.METHODS: To determine the intraoperative diagnostic EndoFLIP values for patients with achalasia, we determined the optimal cut-off points of the distensibility index (DI) between patients with a diagnosis of achalasia and patients with a diagnosis of hiatal hernia. To evaluate the usefulness of EndoFLIP values during Heller myotomy and Dor fundoplication, we obtained a cohort of patients with EndoFLIP values obtained after Heller myotomy and after Dor fundoplication as well as Eckardt score before and after surgery.RESULTS: Our analysis of 169 patients (133 hiatal hernia and 36 achalasia) showed that patients with DI < 0.8 have a >99% probability of having achalasia, while DI > 2.3 have a >99% probability of having hiatal hernia. Patients with a DI 0.8-1.3 have a 95% probability of having achalasia, and patients with a DI of 1.4-2.2 have a 94% probability of having a hiatal hernia. There were 40 patients in the cohort to determine objective data during Heller myotomy and Dor fundoplication. The DI increased from a median of 0.7 to 3.2 after myotomy and decreased to 2.2 after Dor fundoplication (p < 0.001). The median Eckardt score went down from a median of 4.5 to 0 (p < 0.001).CONCLUSIONS: Our study shows that intraoperative use of EndoFLIP can facilitate the diagnosis of achalasia and is used as an adjunct to diagnose achalasia when symptoms are inconsistent. The routine use of EndoFLIP during Heller myotomy and Dor fundoplication provides objective data during the operation in a group of patients with excellent short-term outcomes.

KW - Achalasia

KW - Distensibility index

KW - Dor fundoplication

KW - Dysphagia

KW - EndoFLIP

KW - Endoluminal functional lumen imaging probe

KW - Heller myotomy

KW - Hiatal hernia

KW - Humans

KW - Laparoscopy/methods

KW - Treatment Outcome

KW - Esophageal Achalasia/diagnosis

KW - Heller Myotomy

KW - Fundoplication/methods

KW - Hernia, Hiatal/diagnosis

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UR - http://www.scopus.com/inward/citedby.url?scp=85105070230&partnerID=8YFLogxK

U2 - 10.1007/s00464-021-08517-8

DO - 10.1007/s00464-021-08517-8

M3 - Article

C2 - 33948715

AN - SCOPUS:85105070230

SN - 0930-2794

VL - 36

SP - 2365

EP - 2372

JO - Surgical Endoscopy

JF - Surgical Endoscopy

IS - 4

ER -

Intraoperative diagnosis and treatment of Achalasia using EndoFLIP during Heller Myotomy and Dor fundoplication

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