Real-time intraoperative functioning lumen imaging probe during endoscopic per-oral pyloromyotomy (pop)

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Medical Device Technology

Background:

• Medically refractory gastroparesis presents a treatment challenge.
• Per-oral pyloromyotomy (POP) is an effective first-line therapy.
• Standardized tools for measuring pyloric distensibility during POP are lacking.

Purpose of the Study:

• To evaluate the utility of impedance planimetry with a functional luminal imaging probe (FLIP) for measuring pyloric distensibility changes during POP.
• To compare FLIP measurements with symptom improvement and objective gastric emptying.

Main Methods:

• 14 patients with gastroparesis underwent POP with pre- and post-procedure FLIP measurements.
• Gastroparesis Cardinal Symptom Index (GCSI) and scintigraphic gastric emptying studies (GES) were used for symptom and emptying evaluation.

Main Results:

• Mean pyloric diameter increased significantly (13.9 mm to 15.3 mm, p=0.0012).
• Mean distensibility index improved (6.2 mm²/mmHg to 9.1 mm²/mmHg, p=0.0074).
• POP achieved 100% success with no complications; mean hospital stay was 0.7 days.
• GCSI scores improved (2.97 to 2.28, p<0.001) and 80% of patients showed improved GES (4-hr retention decreased from 46.3% to 32.4%, p<0.007).

Conclusions:

• FLIP is a safe and feasible tool providing objective measurements during POP.
• Further studies with larger cohorts and longer follow-up are needed to confirm if FLIP-measured distensibility predicts sustained symptom and emptying improvements.