Background: Per-oral pyloromyotomy (POP), also known as gastric per-oral endoscopic myotomy, is the first-line endoscopic intervention for medically refractory gastroparesis. This study aimed to assess the value of pyloric impedance planimetry using a functional lumen imaging probe (FLIP) during POP.
Methods: Patients who underwent POP between October 2019 and February 2024 were retrospectively reviewed. FLIP measurements, symptoms measured using the Gastroparesis Cardinal Symptom Index (GCSI), and gastric emptying scintigraphy (GES) were evaluated before and after POP.
Results: Of 35 patients who underwent POP, 29 (82.9%) were female, the median age was 51.3 years (IQR, 38.4-60.9), and the median body mass index was 29.26 kg/m (IQR, 25.46-32.56). In addition, 23 patients had pre- and post-POP FLIP measurements. The median pyloric diameter increased from 14.4 (IQR, 12.0-16.0) to 16.0 (IQR, 14.8-18.0) mm (S = 116.5; P < .0001). The median distensibility index increased from 4.85 (IQR, 3.38-6.00) to 8.45 (IQR, 5.25-11.00) mm/mm Hg (S = 112; P < .0001). The management changed based on FLIP values for 5 patients (21.7%), prompting additional myotomy. At 18.0 days (IQR, 12.8-47.8) after the procedure, the median GCSI score decreased from 3.33 (IQR, 2.56-4.12) preoperatively to 2.00 (IQR, 1.00-2.89) postoperatively (S = -193; P < .001). At a median follow-up of 136 days (IQR, 114-277), improvement in GCSI score persisted, with a median score of 2.44 (IQR, 1.44-3.67) (S = -61; P = .021). The median retention at 4 hours on GES decreased from 29.0% (IQR, 16.5-52.0%) to 19.5% (IQR, 5.75-35.30%) at 97 days (IQR, 88-130) after the procedure (S = -108; P = .0038). There was a 75% improvement and a 40% normalization in objective gastric emptying (n = 26). A greater increase in diameter after pyloromyotomy was associated with a greater decrease in 4-hour gastric retention (r = -0.4886; P = .021).
Conclusion: POP with FLIP resulted in clinical and radiographic improvements in patients with gastroparesis. FLIP measurements guided myotomy extent, changing the management in 21.7% of patients, and were associated with gastric emptying, demonstrating its distinct utility in the treatment of gastroparesis.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.gassur.2024.10.011 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Invited Commentary: Pyloric impedance planimetry during endoscopic per-oral pyloromyotomy (POP) guides myotomy extent.
J Gastrointest Surg
November 2024
Division of MIS/Bariatric Surgery, Department of Surgery, University of Virginia, Charlottesville VA.
Pyloric impedance planimetry during endoscopic per-oral pyloromyotomy guides myotomy extent.
J Gastrointest Surg
January 2025
Case Western Reserve University School of Medicine, Cleveland, OH, United States; Division of General Surgery, Department of Surgery, The MetroHealth System, Cleveland, OH, United States.
Background: Per-oral pyloromyotomy (POP), also known as gastric per-oral endoscopic myotomy, is the first-line endoscopic intervention for medically refractory gastroparesis. This study aimed to assess the value of pyloric impedance planimetry using a functional lumen imaging probe (FLIP) during POP.
Methods: Patients who underwent POP between October 2019 and February 2024 were retrospectively reviewed.
Endoscopic pyloromyotomy for treatment of gastroparesis: A new standard or still an experimental approach?
Best Pract Res Clin Gastroenterol
August 2024
Department of Hepatogastroenterology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic; Institute of Physiology, Charles University in Prague, Prague, Czech Republic; Faculty of Medicine, Ostrava University, Ostrava, Czech Republic. Electronic address:
Gastroparesis (GP) can be a severe and debilitating disease. Its pathophysiology is complex and not completely understood. Two principal mechanisms are responsible for the development of symptoms - gastric hypomotility and pylorospasm.
View Article and Find Full Text PDF[Experience with endoluminal functional luminal probe (EndoFLIP) at San Ignacio University Hospital, Bogota, Colombia].
Rev Gastroenterol Peru
July 2024
Pontificia Universidad Javeriana. Bogotá, Colombia.
Introduction: The EndoFLIP (for its acronym in English: endoluminal functional luminal probe) is a system that measures in real time the compliance index of the gastroesophageal junction and secondary esophageal peristalsis, based on the principle of impedance planimetry. Although this technology is relatively new and its diagnostic usefulness is still being evaluated, its use in clinical practice is increasingly recognized, fundamentally in those patients where there is no conclusive manometric diagnosis of esophageal motor pathology, mainly esophagogastric junction outflow obstruction and achalasia.
Objective: The aim of the present study is to describe the experience with EndoFLIP at the San Ignacio University Hospital in Bogotá, Colombia.
Electromechanical coupling and anatomy of the in vivo gastroduodenal junction.
Am J Physiol Gastrointest Liver Physiol
July 2024
Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.
Few biomarkers support the diagnosis and treatment of disorders of gut-brain interaction (DGBI), although gastroduodenal junction (GDJ) electromechanical coupling is a target for novel interventions. Rhythmic "slow waves," generated by interstitial cells of Cajal (ICC), and myogenic "spikes" are bioelectrical mechanisms underpinning motility. In this study, simultaneous in vivo high-resolution electrophysiological and impedance planimetry measurements were paired with immunohistochemistry to elucidate GDJ electromechanical coupling.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!