Impedance planimetry during per-oral endoscopic myotomy is associated with decreased inadvertent capnoperitoneum.

Autor: Mikulski MF; Department of Surgery, University of Massachusetts Chan Medical School - Baystate, Springfield, MA, USA. matthew.mikulski@gmail.com.; Baystate Medical Center, Surgery Education Office, 759 Chestnut Street, Springfield, MA, 01199, USA. matthew.mikulski@gmail.com., Morley TJ; Department of Surgery, University of Massachusetts Chan Medical School - Baystate, Springfield, MA, USA., Debbink KP; Department of Surgery, University of Massachusetts Chan Medical School - Baystate, Springfield, MA, USA., Desilets DJ; Department of Gastroenterology, University of Massachusetts Chan Medical School - Baystate, Springfield, MA, USA., Romanelli JR; Department of Surgery, University of Massachusetts Chan Medical School - Baystate, Springfield, MA, USA.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2024 Jan; Vol. 38 (1), pp. 280-290. Date of Electronic Publication: 2023 Nov 21.
DOI: 10.1007/s00464-023-10526-8
Abstrakt: Background: Per-oral endoscopic myotomy (POEM) has become an accepted minimally invasive alternative to Heller myotomy for the treatment of achalasia and other disorders of esophageal dysmotility. One associated adverse event is the inadvertent creation of capnoperitoneum. A proposed mechanism is that extension of the submucosal tunnel below the esophageal hiatus and onto the gastric wall leads to transmural perforation. We hypothesized that the use of impedance planimetry with the endoscopic functional luminal imaging probe (EndoFLIP) more accurately identifies the esophagogastric junction and helps to better define the myotomy's ideal limits, thus lowering the incidence of inadvertent capnoperitoneum.
Methods: This is a single-center, retrospective review of consecutive POEM cases from 06/11/2011 to 08/08/2022, with EndoFLIP introduced in 2017. Patient and procedural characteristics, including the incidence of clinically significant capnoperitoneum and decompression, were analyzed using univariate and multivariable linear regression statistics.
Results: There were 140 POEM cases identified, 74 (52.9%) of which used EndoFLIP. Clinically significant capnoperitoneum was encountered in 26 (18.6%) cases, with no differences in patient characteristics between those who had capnoperitoneum and those who did not. There was a decreased incidence of capnoperitoneum in cases using EndoFLIP compared to those without (n = 6, 23% vs n = 20, 77%, p = 0.001), with zero instances in the final 56 cases. After adjusting for potentially confounding factors, EndoFLIP use was associated with a - 15.93% (95% confidence interval - 30.68%, - 1.18%) decrease in procedure duration.
Conclusions: The routine use of EndoFLIP during POEM was associated with decreased incidence of clinically significant capnoperitoneum, potentially due to improved myotomy tailoring and decreased duration of insufflation with shorter procedure times.
(© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
Externí odkaz: