Changes in Distensibility Index During an Incremental POEM Myotomy

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.