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New paper published describing the use of EndoFLIP for per-oral endoscopic myotomy (POEM)

11th September 2012

Silvana Perretta, IRCAD, Strasbourg France.
Silvana Perretta, IRCAD, Strasbourg France.

POEM is viewed by some as the first emerging mainstream application of natural orifice translumenal endoscopic surgery (NOTES), a technique whereby no external incision is required to be made by the surgeon, instead using one of the body’s natural orifices for surgical access. In the case of the standard surgical procedure for achalasia, the Heller Myotomy, a surgeon will typically perform a fundoplication after cutting the fibers around the gastroesophageal junction (GEJ)  in order to tighten the relaxed junction to prevent reflux. In the case of POEM this does not happen. It is therefore critical that the minimum number of fibers are cut to adequately open the GEJ, but not so many as to loosen the GEJ to a point where the patient will experience gastroesophageal reflux. EndoFLIP is particularly well suited to the POEM procedure, providing the surgeon with direct visualization of the degree of opening in the GEJ while fibers are being cut, allowing him or her the ability to know when they wish to stop cutting.

A new paper describing the use of EndoFLIP to provide measurements during the per-oral myotomy procedure has been published in Surgical Endoscopy. Titled Intraoperative assessment of esophagogastric junction distensibility during per oral endoscopic myotomy (POEM) for esophageal motility disorders  by Rieder E, Swanström LL, Perretta S, Lenglinger J, Riegler M, Dunst CM, the paper describes the use of EndoFLIP to directly measure the GEJ opening during endoscopic cutting of the fibers around the GEJ.

The recent Gastroenterology publication by Rohof et al for the first time offers some early guidance as to what opening criteria ought to be targeted. Further prospective studies to assess outcomes achieved by targeting these specific opening criteria are being planned.

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