Role of endoscopic functional luminal imaging probe in predicting the outcome of gastric peroral endoscopic pyloromyotomy (with video)

ABSTRACT Background and Aims Endoluminal functional luminal imaging probe (EndoFLIP) is an imaging tool that measures physiological characteristics of gastrointestinal sphincters. In this study we used EndoFLIP to evaluate the association between the pyloric physiological measurements with clinical outcomes of gastric peroral endoscopic myotomy (G-POEM) in patients with refractory gastroparesis. Methods Thirty-seven patients who underwent G-POEM for management of refractory gastroparesis and had EndoFLIP measurements from five centers were evaluated. Cross-sectional area (CSA), balloon pressure (BP), and distensibility index (DI) of the pylorus were evaluated by EndoFLIP at 40 mL and 50 mL balloon fills before and after G-POEM. One-year clinical success and change in gastric emptying study (GES) 3 months after the G-POEM procedure were compared with EndoFLIP measurements. Results Clinical success was achieved in 26 (70%) patients. Post–G-POEM CSA and DI were significantly higher in the clinical success group with both 40 mL (CSA: 89.9 ± 64.8 vs 172.5 ± 71.9 mm2, p=0.003; DI: 5.8 ± 4.4 vs 8.8 ± 6.1 mm2/mm Hg, p=0.043) and 50 mL volume distention (CSA: 140.1 ± 89.9 vs 237.5 ± 80.3 mm2, p=0.003; DI: 5.6 ± 3.3 vs 9.9 ± 6.6 mm2/mm Hg, p=0.049). CSA using 40 mL volume distention, with an area under the curve (AUC) of 0.83 yielded specificity of 91% and sensitivity of 71% at a cut-off point of 154 mm2. Conclusions Post–G-POEM CSA of the pylorus associates with clinical success and improvement of GES after G-POEM. EndoFLIP measurements of pylorus have the potential to be used as a predicting tool of the G-POEM clinical outcome.