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Impedance planimetry and panometry (EndoFLIP™) can replace manometry in preoperative anti-reflux surgery assessment

  • 2023 SAGES Oral
  • Published:
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Abstract

Background

Endoluminal functional impedance planimetry and panometry assesses secondary peristalsis in response to volumetric distention under sedation. We hypothesize that impedance planimetry and panometry can replace high-resolution manometry in the preoperative assessment prior to anti-reflux surgery.

Methods

Single institution prospective data were collected from patients undergoing anti-reflux surgery between 2021 and 2023. A 16-cm functional luminal imaging probe (FLIP) assessed planimetry and panometry prior to surgery under general anesthesia at the start of each case. Panometry was recorded and esophageal contractile response was classified as normal (NCR), diminished or disordered (DDCR), or absent (ACR) in real time by a single panometry rater, blinded to preoperative HRM results. FLIP results were then compared to preoperative HRM.

Results

Data were collected from 120 patients, 70.8% female, with mean age of 63 ± 3 years. There were 105 patients with intraoperative panometry, and 15 with panometry collected during preoperative endoscopy. There were 60 patients (50%) who had peristaltic dysfunction on HRM, of whom 57 had FLIP dysmotility (55 DDCR, 2 ACR) resulting in 95.0% sensitivity. There were 3 patients with normal secondary peristalsis on FLIP with abnormal HRM, all ineffective esophageal motility (IEM). No major motility disorder was missed by FLIP. A negative predictive value of 91.9% was calculated from 34/37 patients with normal FLIP panometry and normal HRM. Patients with normal HRM but abnormal FLIP had larger hernias compared to patients with concordant studies (7.5 ± 2.8 cm vs. 5.4 ± 3.2 cm, p = 0.043) and higher preoperative dysphagia scores (1.5 ± 0.7 vs. 1.1 ± 0.3, p = 0.021).

Conclusion

Impedance planimetry and panometry can assess motility under general anesthesia or sedation and is highly sensitive to peristaltic dysfunction. Panometry is a novel tool that has potential to streamline and improve patient care and therefore should be considered as an alternative to HRM, especially in patients in which HRM would be inaccessible or poorly tolerated.

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Authors and Affiliations

  1. Department of Minimally Invasive Surgery, NorthShore University HealthSystem, 2650 Ridge Avenue, GCSI Suite B665, Evanston, IL, 60201, USA

    Vanessa N. VanDruff, Julia R. Amundson, Stephanie Joseph, Simon Che, Kristine Kuchta, Christopher J. Zimmermann, Shun Ishii, H. Mason Hedberg & Michael B. Ujiki

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

    Vanessa N. VanDruff & Julia R. Amundson

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  1. Vanessa N. VanDruff
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  2. Julia R. Amundson
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  3. Stephanie Joseph
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  4. Simon Che
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  5. Kristine Kuchta
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  6. Christopher J. Zimmermann
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  7. Shun Ishii
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  9. Michael B. Ujiki
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Correspondence to Vanessa N. VanDruff.

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Disclosures

Michael B. Ujiki, scientific advisory board member of Boston Scientific and Apollo, receives payment for lectures from Medtronic and Gore. Vanessa N. VanDruff, Julia R. Amundson, Stephanie Joseph, Simon Che, Chris Zimmermann, H. Mason Hedberg, and Kristine Kuchta have no conflict or financial interests to disclose.

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This manuscript was accepted for an oral presentation at the 2023 Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Conference on March 29, 2023, in Montreal, Quebec, Canada.

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VanDruff, V.N., Amundson, J.R., Joseph, S. et al. Impedance planimetry and panometry (EndoFLIP™) can replace manometry in preoperative anti-reflux surgery assessment. Surg Endosc 38, 339–347 (2024). https://doi.org/10.1007/s00464-023-10419-w

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