Impedance Planimetry (EndoFLIPTM) Measurements Persist Long Term After Anti-Reflux Surgery
*Hoover Wu1, *Mikhail Attaar2, *Harry J Wong2, *Michelle Campbell2, *Kristine Kuchta2, *Woody Denham2, *Stephen Haggerty2, John Linn2, Michael B Ujiki2
1The University of Chicago Medicine, Chicago, IL;2Northshore University HealthSystem, Evanston, IL
Impedance planimetry based on the functional lumen imaging probe (FLIP) provides objective measurements of the lower esophageal sphincter during laparoscopic anti-reflux surgery (LARS). However, there is a lack of data on how FLIP measurements change at follow up. We aim to describe our institutional experience in performing FLIP during postoperative endoscopy after LARS.
A retrospective review of a prospectively maintained quality database was performed. Patients who underwent LARS during 2018 to 2020 who had postoperative endoscopic FLIP measurements were assessed at different time points using paired t-tests. Reflux Symptom Index (RSI), Gastroesophageal Reflux Disease-Health Related Quality of Life Questionnaire (GERD-HRQL), and Dysphagia Score were collected up to two years. Group comparisons were made using the wilcoxon rank-sum test.
Forty-six patients who underwent LARS (magnetic sphincter augmentation (MSA), Toupet fundoplication, or Nissen fundoplication) had postoperative FLIP, and were compared to their ending intraoperative FLIP values during LARS. Endoscopy and FLIP was performed 15.0±12.0 months after surgery. Postoperative FLIP measurements of Nissen or Toupet fundoplications did not differ from intraoperative values (p>0.05). Postoperative FLIP distensibility index (DI) for MSA patients was decreased however not significantly (p=0.079). FLIP measurements for all recorded postoperative endoscopies showed that MSA had the lowest DI compared to Toupet or Nissen fundoplication (2.5±1.6 mm2/mmHg vs 3.9±2.0 mm2/mmHg or 3.8±2.4 mm2/mmHg, p<0.048). Patients with complaints of postoperative dysphagia or GERD had a decreased DI compared to asymptomatic patients (2.3±1.4 vs 4.5±1.9 mm2/mmHg, p=0.009) on postoperative FLIP and a worse GERD-HRQL score (7.2±5.0 vs 2.3±1.4, p=0.023) at one year follow-up.
CONCLUSIONS: Our results show that FLIP measurements after LARS persist at long-term follow up. FLIP has the potential to assess the success or failure after LARS and optimize patient outcomes.
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