Can FLIP guide therapy in idiopathic esophagogastric junction outflow obstruction?

2021 ◽  
Author(s):  
Claire A Beveridge ◽  
Joseph R Triggs ◽  
Shivani U Thanawala ◽  
Nitin K Ahuja ◽  
Gary W Falk ◽  
...  
Keyword(s):  
Esophagogastric Junction ◽  
Barium Swallow ◽  
Outflow Obstruction ◽  
Chi Square ◽  
Bolus Transit ◽  
Paired Samples ◽  
Eckardt Score ◽  
Symptom Response ◽  
Clinically Significant

Abstract Background Esophagogastric junction outflow obstruction (EGJOO) has a variable disease course. Currently, barium swallow (BaS) and manometric parameters are used to characterize clinically significant EGJOO. The esophagogastric junction distensibility index (EGJ-DI) measured via functional lumen imaging probe (FLIP) can provide complementary information. Our aim was to assess symptom response in patients with EGJOO and an abnormal EGJ-DI after botulinum toxin (BT) treatment. Methods A prospective cohort study of adults with idiopathic EGJOO was performed from September 2019 to March 2021. Patients with dysphagia underwent upper endoscopy with FLIP. If the EGJ-DI was abnormally low, BT was injected. Data examined included demographics, medical history, endoscopic and FLIP findings, BaS, manometry, and Eckardt score (ES). ES improvement was assessed via paired samples t-test. Pearson’s chi-square tests were used to assess for associations. Results Of the 20 patients, 75% had an abnormal EGJ-DI and underwent BT injections. Mean ES for patients with abnormal EGJ-DIs significantly improved from baseline to 1, 3, and 6 month follow-up (P-values: 0.01, 0.05, and 0.02, respectively). There was a significant association between an abnormal EGJ-DI with delayed bolus transit and presence of rapid drink challenge panesophageal pressurization on manometry: P = 0.03 and P = 0.03. Conclusion This prospective study revealed that an abnormal EGJ-DI can guide BT as assessed via symptomatic response. Additionally, abnormal EGJ-DI measurements were significantly associated with other parameters used previously to determine clinically relevant EGJOO. Larger follow-up studies are warranted to further elucidate guidance for therapy in EGJOO.

Tu1396 BOLUS TRANSIT IN ESOPHAGOGASTRIC JUNCTION OUTFLOW OBSTRUCTION (EGJOO) WITH OR WITHOUT ESOPHAGEAL BODY DYSMOTILITY: A MULTICENTER ANALYSIS

2020 ◽  
Vol 158 (6) ◽  
pp. S-1089
Author(s):  
Danny Wong ◽  
Daniela Jodorkovsky ◽  
Daniel Sikavi ◽  
Ryan Leung ◽  
Wai-Kit Lo ◽  
...  
Keyword(s):  
Esophagogastric Junction ◽  
Outflow Obstruction ◽  
Bolus Transit ◽  
Esophageal Body ◽  
Multicenter Analysis

Characterization and follow-up of esophagogastric junction outflow obstruction detected by high resolution manometry

2015 ◽  
Vol 28 (1) ◽  
pp. 116-126 ◽  
Author(s):  
M.-T. Pérez-Fernández ◽  
C. Santander ◽  
A. Marinero ◽  
D. Burgos-Santamaría ◽  
C. Chavarría-Herbozo
Keyword(s):  
High Resolution ◽  
Esophagogastric Junction ◽  
Outflow Obstruction ◽  
High Resolution Manometry

scholarly journals Outcomes of anterior myotomy versus posterior myotomy during POEM: a randomized pilot study

2018 ◽  
Vol 06 (02) ◽  
pp. E190-E198 ◽  
Author(s):  
Mohan Ramchandani ◽  
Zaheer Nabi ◽  
D. Reddy ◽  
Rahul Talele ◽  
Santosh Darisetty ◽  
...  
Keyword(s):  
Randomized Study ◽  
Acid Exposure ◽  
Barium Swallow ◽  
Eckardt Score ◽  
Posterior Group ◽  
Endoscopic Myotomy ◽  
Esophageal Emptying ◽  
Ph Metry ◽  
Equal Efficacy

Abstract Background and study aims Peroral endoscopic myotomy (POEM) can be performed via an anterior or posterior approach, depending on the operator’s preference. Data are lacking on comparative outcomes of both approaches. Patients and methods This is a pilot randomized study comparing endoscopic anterior and posterior myotomy during POEM in patients with Achalasia cardia (AC). Patients were randomized into 2 groups (n = 30 in each group); anterior myotomy group (AG) and posterior myotomy group (PG) and were followed at 1, 3 and 6 months after POEM. Results Technical success was achieved in 100 % of cases in both groups and total operative time was comparable (AG – 65 ± 17.65 minutes versus PG – 61.2 ± 16.67; P = 0.38); Mucosotomies were more frequent in AG (20 % vs 3.3 %; P = 0.02). Difference in other perioperative adverse events (AE) including insufflation-related AE and bleeding in both groups were statistically insignificant. At 1-month follow-up Eckardt score AG 0.57 ± 0.56 vs PG 0.53 ± 0.71; (P = 0.81), mean LES pressure AG 11.93 ± 6.36 vs PG 11.77 ± 6.61; (P = 0.59) and esophageal emptying on timed barium swallow at 5 minutes AG 1.32 ± 1.08 cm vs PG 1.29 ± 0.79 cm; (P = 0.09) were comparable in both groups. At 3 months, Eckardt score (0.52 ± 0.59 vs 0.63 ± 0.62; P = 0.51) was similar in both groups. Incidence of esophagitis on EGD was comparable in both groups (24 % vs 33.3 %; P = 0.45), however, pH metry at 3 months showed significantly more esophageal acid exposure in posterior group (2.98 % ± 4.24 vs 13.99 % ± 14.48; P < 0.01). At 6 months clinical efficacy and LES pressures were comparable in both groups. Conclusion Anterior and posterior approaches to POEM seem to have equal efficacy. However, the occurrence of mucosotomies was higher in the anterior myotomy group and acid exposure was higher with the posterior myotomy approach during POEM.

scholarly journals Assessment of Esophageal High-Resolution Impedance Manometry in Patients with Nonobstructive Dysphagia

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Zhaoyu Liu ◽  
Jiazhi Liao ◽  
Dean Tian ◽  
Mei Liu ◽  
Zili Dan ◽  
...  
Keyword(s):  
High Resolution ◽  
Esophageal Motility ◽  
Esophagogastric Junction ◽  
Esophageal Motility Disorders ◽  
Outflow Obstruction ◽  
Esophageal Motility Disorder ◽  
Bolus Transit ◽  
Motility Disorders ◽  
Esophageal Transit ◽  
Clinical Diagnoses

Background. High-resolution impedance manometry (HRIM) can calculate the bolus motion parameters and the ratio of complete esophageal transit besides the conventional esophageal dynamic parameters; therefore, we could better manage the patients with nonobstructive dysphagia (NOD) clinically. Aim. To analyze the HRIM parameter results of NOD patients and evaluate the characteristics of their esophageal motility and transit function. Methods. In total, 58 NOD patients were assessed and the clinical diagnoses were determined. HRIM was performed, and both conventional high-resolution manometry and esophageal transit parameters were analyzed. Results. In 58 NOD patients, 28 patients had achalasia, 3 esophagogastric junction outflow obstruction, and 20 nonspecific esophageal motility disorders, and 7 were normal. Impedance results demonstrated that all the patients with achalasia exhibited incomplete esophageal transit (ICET), three patients with esophagogastric junction outflow obstruction showed ICET, and the average bolus transit time (BTT) was 6.6 ± 1.2 sec. In 20 nonspecific esophageal motility disorders, 13 patients with gastroenterologly reflux disease (GERD) presented ineffective esophageal motility and fragmented peristalsis, and 65.0% swallows had exhibited ICET. However, 49.1% swallows of 7 nonspecific esophageal motility disorder patients with non-GERD had exhibited ICET. The average BTT in 13 GERD patients was longer than that in the non-GERD patients (8.1 ± 1.1 sec versus 5.5 ± 0.3 sec, P<0.05). And in the seven patients with normal esophagus function, 3.5% swallows showed ICET and BTT was 5.6 ± 0.3 sec. Conclusion. Achalasia was the most common esophageal dysmotility in NOD patients, followed by nonspecific esophageal motility disorders. The clinical diagnoses of NOD were mostly achalasia and GERD. Impedance assessments showed that all achalasia cases exhibited ICET, and other esophageal motility abnormalities that represented ICET were associated with contraction break and ineffective swallow. Compared to non-GERD patients, BTT was significantly prolonged in patients with GERD.

scholarly journals Revisional Therapy for Recurrent Symptoms After Heller Myotomy for Achalasia

2021 ◽  
Author(s):  
Pamela Milito ◽  
Stefano Siboni ◽  
Andrea Lovece ◽  
Erika Andreatta ◽  
Emanuele Asti ◽  
...  
Keyword(s):  
Heller Myotomy ◽  
Tertiary Care ◽  
Final Analysis ◽  
Esophageal Achalasia ◽  
University Hospital ◽  
Barium Swallow ◽  
Upper Gastrointestinal Endoscopy ◽  
Pneumatic Dilation ◽  
Eckardt Score

Abstract Purpose Symptom recurrence after initial surgical management of esophageal achalasia occurs in 10–25% of patients. The aim of this study was to analyze safety and efficacy of revisional therapy after failed Heller myotomy (HM). Methods A retrospective review of a prospective database was performed searching for patients with recurrent symptoms after primary surgical therapy for achalasia. Patients with previously failed HM were considered for the final analysis. The Foregut questionnaire, and the Atkinson and Eckardt scales were used to assess severity of symptoms. Objective investigations routinely included upper gastrointestinal endoscopy and barium swallow study. Redo treatments consisted of endoscopic pneumatic dilation (PD), laparoscopic HM, hybrid Ivor Lewis esophagectomy, or stapled cardioplasty. A yearly clinical and endoscopic follow-up was scheduled in all patients. Results Over a 20-year period, 26 patients with a median age of 66 years (IQR 19.5) underwent revisional therapy after failed HM for achalasia at a tertiary-care university hospital. The median time after index procedure was 10 years (IQR 21). Revisional therapy consisted of endoscopic pneumatic dilation (n=13), laparoscopic HM and fundoplication (n=10), esophagectomy (n=2), and stapled cardioplasty and fundoplication (n=1). Nine (34.6%) of these patients required further endoscopic or surgical treatments. There was no mortality, and the overall complication rate was 7.7%. At a median follow-up of 42 months (range 10–149), a significant decrease of dysphagia, regurgitation, chest pain, respiratory symptoms, and median Eckardt score (p<0.05) was noted. Conclusion In specialized and multidisciplinary centers, revisional therapy for achalasia is feasible, safe, and effective.

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