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New paper describes the intraoperative use of EndoFLIP to guide POEM surgery

A new paper EndoFLIP system for the intraoperative evaluation of peroral endoscopic myotomy has been published in the United European Gastroenterology Journal, which describes the use of EndoFLIP to oversee the myotomy procedure during POEM surgery.
The paper is authored by Pietro Familiari, Giovanni Gigante, Michele Marchese, Ivo Boskoski, Vincenzo Bove, Andrea Tringali, Vincenzo Perri, Graziano Onder and Guido Costamagna from the Gemelli University Hospital, Universita` Cattolica del Sacro Cuore, Rome, Italy.


Background: Peroral endoscopic myotomy (POEM) has been recently introduced in clinical practice for the treatment of achalasia. The endoluminal functional lumen imaging probe (EndoFLIP) system) uses impedance planimetry for the realtime measurement of the diameter of the oesophago-gastric junction.
Objective: The aim of this study is to prospectively evaluate the effect of POEM on the oesophago-gastric junction using EndoFLIP.
Methods: All the patients who underwent POEM in a single centre between April and July 2013 were enrolled in the study. EndoFLIP was used intraoperatively, immediately before and after POEM. During follow-up patients underwent oesophagogastroduodenoscopy, oesophageal pH monitoring and manometry. Clinical outcomes were compared with the diameter of the oesophago-gastric junction after POEM.
Results: In total, 23 patients (12 males, mean age 51.7 years) were enrolled, and 21 underwent POEM successfully. Preoperative mean basal lower oesophageal sphincter pressure was 42.1 mmHg (_17.6). Before POEM, the mean oesophago-gastric junction diameter and cross-sectional area were 6.3mm (_1.8) and 32.9 mm2 (_23.1), respectively. After treatment, the mean diameter and cross-sectional area of the oesophago-gastric junction were 11.3mm (_1.7 SD) and 102.38 mm2 (_28.2 SD), respectively. No complications occurred during a mean follow-up of 5 months. Median postoperative Eckardt score was 1. Three patients (14.3%) referred heartburn. Follow-up studies revealed gastro-oesophageal reflux disease (GORD) in 57.1% of patients and oesophagitis in 33.3%. No correlations were observed between the diameter of oesophago-gastric junction after POEM and symptoms relief, GORD incidence and lower oesophageal sphincter pressure.
Conclusions: The diameter of oesophago-gastric junction substantially increases after POEM. EndoFLIP is a reliable method for the intraoperative evaluation of oesophago-gastric junction diameter. However, the real usefulness of this technology after POEM remains controversial.

A full copy of the paper may be found at

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