Ryan A J Campagna1, Dustin A Carlson2, Eric S Hungness1, Amy L Holmstrom1, John E Pandolfino2, Nathaniel J Soper1, Ezra N Teitelbaum3. 1. Department of Surgery, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 650, Chicago, IL, 60611, USA. 2. Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 3. Department of Surgery, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 650, Chicago, IL, 60611, USA. ezra.teitelbaum@nm.org.
Abstract
BACKGROUND: The functional luminal imaging probe (FLIP) can evaluate esophagogastric junction (EGJ) distensibility and esophageal peristalsis in real time. FLIP measurements performed during diagnostic endoscopy can accurately discriminate between healthy controls and patients with achalasia based on EGJ-distensibility and distinct motility patterns termed repetitive antegrade contractions (RACs) and repetitive retrograde contractions (RRCs). We sought to evaluate real-time motility changes in patients undergoing surgical myotomy for achalasia. METHODS: FLIP measurements using a stepwise volumetric distention protocol were performed at three time points during assessment and performance of laparoscopic Heller myotomy and POEM: (1) During preoperative outpatient endoscopy, (2) Intraoperatively following induction of anesthesia, and (3) Intraoperatively after myotomy completion. EGJ-distensibility, contractility, RACs, and RRCs were measured. RESULTS: FLIP measurements were performed in 32 patients. The EGJ-distensibility index was similar between the preoperative and initial operative measurements (1.1 vs 1.4 mm2/mmHg, p = NS). There was a significant increase in distensibility following surgical myotomy (1.4 to 4.7 mm2/mmHg, p < 0.01). Intraoperative contractile patterns varied between achalasia subtypes. Contractility was seen in < 20% of assessments in patients with types I and II achalasia. Type III patients demonstrated contractility in 100% of assessments, with 70% exhibiting RRCs and 60% RACs. There was a reduction in the frequency of RRC presence (70% to 20%), and contractile vigor (80% to 0% of patients with lumen occluding contractions) in type III patients following surgical myotomy. CONCLUSIONS: This first report of real-time intraoperative measurement of esophageal motility using FLIP demonstrates the feasibility of such assessments during surgical myotomy for achalasia. Patients with type I and II achalasia exhibited rare intraoperative contractility, while the presence of motility was the norm in those with type III. Patients with type III achalasia demonstrated an immediate reduction in repetitive contraction motility patterns and contractile vigor following myotomy.
BACKGROUND: The functional luminal imaging probe (FLIP) can evaluate esophagogastric junction (EGJ) distensibility and esophageal peristalsis in real time. FLIP measurements performed during diagnostic endoscopy can accurately discriminate between healthy controls and patients with achalasia based on EGJ-distensibility and distinct motility patterns termed repetitive antegrade contractions (RACs) and repetitive retrograde contractions (RRCs). We sought to evaluate real-time motility changes in patients undergoing surgical myotomy for achalasia. METHODS: FLIP measurements using a stepwise volumetric distention protocol were performed at three time points during assessment and performance of laparoscopic Heller myotomy and POEM: (1) During preoperative outpatient endoscopy, (2) Intraoperatively following induction of anesthesia, and (3) Intraoperatively after myotomy completion. EGJ-distensibility, contractility, RACs, and RRCs were measured. RESULTS: FLIP measurements were performed in 32 patients. The EGJ-distensibility index was similar between the preoperative and initial operative measurements (1.1 vs 1.4 mm2/mmHg, p = NS). There was a significant increase in distensibility following surgical myotomy (1.4 to 4.7 mm2/mmHg, p < 0.01). Intraoperative contractile patterns varied between achalasia subtypes. Contractility was seen in < 20% of assessments in patients with types I and II achalasia. Type III patients demonstrated contractility in 100% of assessments, with 70% exhibiting RRCs and 60% RACs. There was a reduction in the frequency of RRC presence (70% to 20%), and contractile vigor (80% to 0% of patients with lumen occluding contractions) in type III patients following surgical myotomy. CONCLUSIONS: This first report of real-time intraoperative measurement of esophageal motility using FLIP demonstrates the feasibility of such assessments during surgical myotomy for achalasia. Patients with type I and II achalasia exhibited rare intraoperative contractility, while the presence of motility was the norm in those with type III. Patients with type III achalasia demonstrated an immediate reduction in repetitive contraction motility patterns and contractile vigor following myotomy.
Authors: Dustin A Carlson; Zhiyue Lin; Peter J Kahrilas; Joel Sternbach; Erica N Donnan; Laurel Friesen; Zoe Listernick; Benjamin Mogni; John E Pandolfino Journal: Gastroenterology Date: 2015-08-14 Impact factor: 22.682
Authors: Ezra N Teitelbaum; Nathaniel J Soper; John E Pandolfino; Peter J Kahrilas; Lubomyr Boris; Frédéric Nicodème; Zhiyue Lin; Eric S Hungness Journal: Surg Endosc Date: 2014-05-23 Impact factor: 4.584
Authors: Saowanee Ngamruengphong; Burkhard H A von Rahden; Jörg Filser; Amy Tyberg; Amit Desai; Reem Z Sharaiha; Arnon Lambroza; Vivek Kumbhari; Mohamad El Zein; Ahmed Abdelgelil; Sepideh Besharati; John O Clarke; Ellen M Stein; Anthony N Kalloo; Michel Kahaleh; Mouen A Khashab Journal: Surg Endosc Date: 2015-10-20 Impact factor: 4.584
Authors: P J Kahrilas; A J Bredenoord; M Fox; C P Gyawali; S Roman; A J P M Smout; J E Pandolfino Journal: Neurogastroenterol Motil Date: 2014-12-03 Impact factor: 3.598
Authors: Ryan A J Campagna; Arturo Cirera; Amy L Holmstrom; Joseph R Triggs; Ezra N Teitelbaum; Dustin A Carlson; John E Pandolfino; Eric S Hungness Journal: Ann Surg Date: 2021-06-01 Impact factor: 13.787
Authors: Amy L Holmstrom; Ryan J Campagna; Dustin A Carlson; John E Pandolfino; Nathaniel J Soper; Eric S Hungness; Ezra N Teitelbaum Journal: Gastrointest Endosc Date: 2021-03-01 Impact factor: 10.396