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Using impedance planimetry (EndoFLIP™) in the operating room to assess gastroesophageal junction distensibility and predict patient outcomes following fundoplication

  • 2019 SAGES Oral
  • Published:
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Abstract

Introduction

The purpose of this study is to evaluate the utility of using a functional lumen imaging probe (EndoFLIP™) intra-operatively during hiatal hernia repair and fundoplication. Additionally, we hypothesize that these measurements correlate with long-term outcomes.

Methods

A prospectively maintained quality database was queried. Between 2013 and 2018, 175 patients underwent laparoscopic fundoplication, the majority of which also had a hiatal hernia repair. The EndoFLIP™ was used to measure minimum diameter (Dmin), balloon pressure, and distensibility index (DI) at different timepoints throughout the operation. Clinical outcomes were measured up to 2 years after treatment.

Results

Crural closure and fundoplication resulted in a significant increase in balloon pressure and decrease in DI when compared to initial measurements as well as measurements taken after hernia reduction. After 1 year, patients with a final DI < 2.0 mm2/mmHg reported significantly more gas bloat and dysphagia than those with a final DI ≥ 2.0 mm2/mmHg (p = 0.040 and p = 0.025, respectively). This disparity became even more dramatic at 2 years (p = 0.006 and p = 0.004, respectively), with a final DI < 2.0 mm2/mmHg being significantly associated with higher prevalence of daily gas bloat (43.8% vs. 12.0%; p = 0.03). Additionally, patients with a final DI between 2.0 and 3.5 mm2/mmHg reported significantly lower Reflux Symptom Index scores at one year compared to those with a final DI < 2.0 or > 3.5 mm2/mmHg (p = 0.042).

Conclusion

EndoFLIP™ measurements correlate well with patient outcomes, with a final DI between 2 and 3.5 mm2/mmHg potentially being ideal. The EndoFLIP™ can be a useful adjunct in the operating room by providing objective measurements of esophageal distensibility after crural closure and fundoplication.

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Authors and Affiliations

  1. Department of Surgery, Northshore University HealthSystem, 2650 Ridge Ave, GCSI Suite B665, Evanston, IL, 60201, USA

    Bailey Su, Stephanie Novak, Zachary M. Callahan, Kristine Kuchta, JoAnn Carbray & Michael B. Ujiki

  2. Department of Surgery, University of Chicago, Chicago, IL, USA

    Bailey Su

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  1. Bailey Su
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  2. Stephanie Novak
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  3. Zachary M. Callahan
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Correspondence to Bailey Su.

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Disclosures

Dr. Michael B. Ujiki is a speaker for Medtronic, consultant for Olympus, on the Boston Scientific advisory board, a consultant and speaker for Apollo Medical Devices and a speaker for Gore Medical. Dr. Bailey Su, Ms. Stephanie Novak, Dr. Zachary M. Callahan, Ms. Kristine Kuchta and Ms. JoAnn Carbray have no conflicts of interest or financial ties to disclose.

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Su, B., Novak, S., Callahan, Z.M. et al. Using impedance planimetry (EndoFLIP™) in the operating room to assess gastroesophageal junction distensibility and predict patient outcomes following fundoplication. Surg Endosc 34, 1761–1768 (2020). https://doi.org/10.1007/s00464-019-06925-5

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  • DOI: https://doi.org/10.1007/s00464-019-06925-5

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