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PROSPECTIVE ANALYSIS OF ENDOSCOPIC IMPEDANCE PLANIMETRY PYLORIC MEASUREMENTS AND ITS ASSOCIATION WITH TREATMENT OUTCOMES IN PATIENTS WITH GASTROPARESIS UNDERGOING GASTRIC PER-ORAL ENDOSCOPIC MYOTOMY (G-POEM)
Date
May 18, 2024
Background: Endoscopic impedance planimetry (FLIP) has been used to evaluate the pyloric physiologic parameters after G-POEM for refractory gastroparesis; yet data on this technology is still limited. This study aimed to evaluate FLIP measurements and its association with clinical outcomes of patients undergoing G-POEM.
Methods: Single-center prospective study on consecutive patients with confirmed medically refractory gastroparesis who underwent G-POEM. Pylorus diameter, cross-sectional area (CSA), balloon pressure, and distensibility index (DI) were evaluated at 40 mL balloon fills in same session pre-G-POEM, post-G-POEM and subsequently at 3-month FLIP follow-up. Clinical response was defined as improvement of ≥1 point on the Gastroparesis Cardinal Symptom Index (GCSI) at follow-up.
Results: Seventy-seven patients with a median follow-up of 6 months (range 3-12) underwent G-POEM between November 2021 and June 2023. Technical success was 100%. There was one case of perforation (1.3%) managed endoscopically. Clinical success was achieved in 68% (52/77) of the patients. There were no differences in demographics, symptom duration, etiology of gastroparesis, baseline GCSI or gastric emptying scintigraphy results between responders (n=52) and non-responders (n=25) (Table 1). Patients who responded to G-POEM had a lower baseline distensibility index (DI) compared to non-responders (8.1 ± 2.6 vs. 9.9 ± 4.8 mm2/mmHg; p=0.04) (Table 1). Clinical response after G-POEM was associated with improvement in pyloric cross-sectional area (CSA) and DI (Figure 1). Post-G-POEM DI was significantly higher in the responder group (DI: 11.5 ± 3.6 vs. 9.4 ± 5.1 mm2/mmHg; p=0.04).
Conclusions: In this large prospective study with standardized FLIP measurements before and after G-POEM, we demonstrated an association between clinical response following G-POEM and improvement in CSA and pyloric distensibility. Notably, baseline pyloric distensibility, which was significantly lower among clinical responders, may be a potential predictor of treatment response to G-POEM. Future multi-center studies on G-POEM with standardized FLIP protocols are needed to corroborate these initial findings and determine whether this tool can be used to more accurately predict clinical response.
Methods: Single-center prospective study on consecutive patients with confirmed medically refractory gastroparesis who underwent G-POEM. Pylorus diameter, cross-sectional area (CSA), balloon pressure, and distensibility index (DI) were evaluated at 40 mL balloon fills in same session pre-G-POEM, post-G-POEM and subsequently at 3-month FLIP follow-up. Clinical response was defined as improvement of ≥1 point on the Gastroparesis Cardinal Symptom Index (GCSI) at follow-up.
Results: Seventy-seven patients with a median follow-up of 6 months (range 3-12) underwent G-POEM between November 2021 and June 2023. Technical success was 100%. There was one case of perforation (1.3%) managed endoscopically. Clinical success was achieved in 68% (52/77) of the patients. There were no differences in demographics, symptom duration, etiology of gastroparesis, baseline GCSI or gastric emptying scintigraphy results between responders (n=52) and non-responders (n=25) (Table 1). Patients who responded to G-POEM had a lower baseline distensibility index (DI) compared to non-responders (8.1 ± 2.6 vs. 9.9 ± 4.8 mm2/mmHg; p=0.04) (Table 1). Clinical response after G-POEM was associated with improvement in pyloric cross-sectional area (CSA) and DI (Figure 1). Post-G-POEM DI was significantly higher in the responder group (DI: 11.5 ± 3.6 vs. 9.4 ± 5.1 mm2/mmHg; p=0.04).
Conclusions: In this large prospective study with standardized FLIP measurements before and after G-POEM, we demonstrated an association between clinical response following G-POEM and improvement in CSA and pyloric distensibility. Notably, baseline pyloric distensibility, which was significantly lower among clinical responders, may be a potential predictor of treatment response to G-POEM. Future multi-center studies on G-POEM with standardized FLIP protocols are needed to corroborate these initial findings and determine whether this tool can be used to more accurately predict clinical response.
Table 1. Baseline and Procedural Characteristics
Figure 1. Endoscopic functional luminal impedance planimetry (FLIP) measurements of pyloric distensibility index (DI) (A) and cross-sectional area (CSA) (B) before and after G-POEM among clinical responders vs non-responders.
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