Usefulness of EndoFLIP in Diverticular Peroral Endoscopic Myotomy for Symptomatic Epiphrenic Diverticulum
- Author:
Jin Hee NOH
1
;
Do Hoon KIM
;
Kee Wook JUNG
;
Hee Kyong NA
;
Ji Yong AHN
;
Jeong Hoon LEE
;
Kee Don CHOI
;
Ho June SONG
;
Gin Hyug LEE
;
Hwoon-Yong JUNG
Author Information
- Publication Type:Original Article
- From:Journal of Neurogastroenterology and Motility 2023;29(2):183-191
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background/Aims:Diverticular peroral endoscopic myotomy (D-POEM) is known to be a safe and feasible technique for managing diverticular diseases of the esophagus. In this study, we aim to report our experience with D-POEM and to investigate the usefulness of endoscopic functional luminal imaging probe (EndoFLIP) in determining the need for cardiomyotomy with septotomy for symptomatic epiphrenic diverticulum.
Methods:Consecutive patients who underwent D-POEM for symptomatic epiphrenic diverticulum between September 2019 and September 2021 were eligible for this study. EndoFLIP and high-resolution manometry results and endoscopic treatment outcomes were retrospectively investigated.
Results:A total of 9 patients with symptomatic epiphrenic diverticulum were included. The median size of the diverticulum and septum was 50 (interquartile range [IQR], 48-80) mm and 20 (IQR, 20-30) mm, respectively. The overall technical success rate was 100%, with a median procedure time of 60 (IQR, 46-100) minutes. The 5 patients (high-resolution manometry results; 3 normal, 1 ineffective esophageal motility, and 1 Jackhammer esophagus) who had decreased esophagogastric junction distensibility index on pre-procedure EndoFLIP underwent cardiomyotomy with septotomy regardless of the presence of esophageal motility disorders, and the distensibility index increased and normalized after procedure. The mean dysphagia score decreased from 2.0 ± 1.0 pre-procedure to 0.4 ± 0.7 during a median follow-up of 11 (IQR, 4-21) months post-procedure. No serious adverse events that required surgical intervention or delayed discharge were noted.
Conclusions:EndoFLIP may help decide whether to perform combined cardiomyotomy and septotomy for the treatment of an epiphrenic diverticulum. Further large-scale studies are needed to confirm these results.
