Does the use of EndoFLIP during fundoplications improve outcomes?

Impedance planimetry (EndoFLIP) provides a powerful intraoperative tool to the trained Foregut surgeon. Real time data on esophageal diameter and distensibility index (DI) allows for objective biofeedback to improve the overall consistency of the operation. While EndoFLIP carries great potential, little has been said about its effect toward postoperative outcomes. Our goal for this study was to identify how certain EndoFLIP scores would impact postoperative patient surveys.

A prospectively collected database of patients undergoing crural repair between January 2023 and September 2024 was reviewed. EndoFLIP measurements of DI and diameter were obtained after fundoplication using a standardized protocol. Patients were then surveyed postoperatively at 2 months, 6 months, and 1-year intervals to trend changes in GERD-HRQL, REGURG, LPR-RSI, and Dysphagia scores. Spearman Rank correlation was used to assess linear relationships between post-fundoplication measurements and quality-of-life scores at follow up.

A total of 55 patients were reviewed in this study. All patients underwent a crural repair while 45% underwent an anterior wrap and 55% a posterior wrap. Diameter and DI measurements were not found to correlate with GERD-HRQL or LPR-RSI scores at 1-year postoperative visits. No correlation was also found when looking at the change in scores from preoperative to postoperative surveys. Larger DI and diameters did correlate to higher REGURG scores at 1-year follow ups.

Intraoperative DI and diameter measurements carry almost no correlation to postoperative outcome scores. Only a positive correlation to REGURG scores with higher DI and diameter were noted. As long as DI is kept between extreme values, other factors must be investigated as part of a multifactorial influence to postoperative dysphagia and GERD.