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

摘要

Introduction The purpose of this study is to evaluate the utility of using a functional lumen imaging probe (EndoFLIP (TM)) 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 (TM) was used to measure minimum diameter (D-min), 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 mm(2)/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 3.5 mm(2)/mmHg (p = 0.042). Conclusion EndoFLIP (TM) measurements correlate well with patient outcomes, with a final DI between 2 and 3.5 mm(2)/mmHg potentially being ideal. The EndoFLIP (TM) can be a useful adjunct in the operating room by providing objective measurements of esophageal distensibility after crural closure and fundoplication.