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Related Experiment Video

Updated: Jun 23, 2026

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Changes in Distensibility Index During an Incremental POEM Myotomy.

Tom B Knowles1, Anee Sophia Jackson1, Shu-Ching Chang2

  • 1Division of Thoracic Surgery, Swedish Digestive Health Institute and Medical Center, Suite 900, 1101 Madison Street, Seattle, WA, 98104, USA.

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
|March 2, 2022
PubMed
Summary

A shorter per oral endoscopic myotomy (POEM) may suffice for achalasia treatment. Using the endoscopic functional luminal image probe (EndoFLIP) intra-operatively allows for tailored myotomy length, optimizing patient outcomes.

Keywords:
AchalasiaDistensibility indexEndoFLIPEndoscopyEsophagusMyotomyPOEM

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Area of Science:

  • Gastroenterology
  • Minimally Invasive Surgery
  • Esophageal Motility Disorders

Background:

  • Longer myotomy for achalasia treatment can worsen reflux.
  • Clinical outcomes are linked to distal esophageal distensibility.
  • Endoscopic functional luminal image probe (EndoFLIP) measures distensibility intra-operatively.

Purpose of the Study:

  • Determine the minimum per oral endoscopic myotomy (POEM) length for adequate distensibility.
  • Correlate POEM length with functional luminal imaging measurements.
  • Optimize POEM procedures for achalasia patients.

Main Methods:

  • Performed 6-cm POEM in 2-cm increments on 16 achalasia patients (types I and II).
  • Measured distensibility index (DI) using EndoFLIP at five stages: pre-intervention, post-tunnel, post-HPZ transection, post-distal extension, and post-proximal extension.
  • Analyzed DI changes relative to myotomy length increments.

Main Results:

  • Median DI increased with each myotomy increment.
  • Target DI range was achieved in 50% of patients after HPZ transection.
  • Most patients achieved target DI with a 2-4 cm myotomy.

Conclusions:

  • Distensibility improves with incremental myotomy.
  • A shorter myotomy (2-4 cm) may be adequate for select achalasia patients.
  • Intra-operative EndoFLIP use enables tailored POEM length, potentially improving outcomes.