Role of functional luminal imaging probe in the management of postmyotomy clinical failure

Yervant Ichkhanian, Olaya Brewer Gutierrez, Sabine Roman, In Kyung Yoo, Andrew Canakis, Rishi Pawa, Kenneth Koch, Bailey Su, Michael Ujiki, Eva Alsheik, Tobias Zuchelli, Cyrus Piraka, Bachir Ghandour, Linda Zhang, Joshua A. Sloan, Mouen A. Khashab

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


BACKGROUND AND AIMS: A small percentage of patients with esophageal dysmotility disorders (EDDs) fail to improve or relapse after management by laparoscopic Heller myotomy (LHM) and peroral endoscopic myotomy (POEM). In this study, we aimed to describe the role of functional luminal imaging probe (FLIP) in identifying patients who might benefit from lower esophageal sphincter (LES)-directed retreatment.

METHODS: This was a retrospective study at 6 tertiary care centers (United States, 4; Europe, 1; Asia, 1) between January 2015 and April 2021 involving patients with prior failed myotomy. The primary outcome was the impact of the use of FLIP on the management of patients with prior failed myotomy.

RESULTS: One hundred twenty-three patients (62 women [50%]; mean age, 53 ± 21.1 years) who underwent LHM (n = 53, 43%) or POEM (n = 70, 57%) for the management of achalasia (n = 98) or other EDDs (n = 25) had clinical failure at a median time of 10.8 months (interquartile range, .8-17.3) postprocedure. Twenty-nine patients had apposing "abnormal" diagnoses in terms of integrated relaxation pressure (IRP) >15 mm Hg on HRM and distensibility index (DI) <2.8 mm 2/mm Hg on FLIP, with ultimate change in management noted in 15 patients (10 directed toward conservative management, 5 directed toward LES-directed retreatment). The impact of FLIP on both diagnosis and management was noted in 15 of 29 patients (52%). In the subgroup analysis of 44 patients who underwent LES-directed retreatment, clinical success was highest among patients with both abnormal IRP and DI (21/25 [84%]) versus patients with only abnormal IRP (8/14 [57%]) or only abnormal DI (3/5 [60%], P = .04), with DI at 40-mL distension volume on FLIP identified as an independent predictor of clinical success (odd ratio, 1.51; 95% confidence interval, 1.02-2.1; P = .03).

CONCLUSIONS: The finding of this study further suggests the important role of using FLIP in addition to HRM in evaluating patients with clinical failure postmyotomy.

Original languageEnglish (US)
Pages (from-to)9-17.e3
JournalGastrointestinal endoscopy
Issue number1
StatePublished - Jul 2022

Bibliographical note

Funding Information:
DISCLOSURE: The following authors disclosed financial relationships: S. Roman: Research support from Medtronic and Diversatek Healthcare; consultant for Reckitt Benckiser. M. Ujiki: Board member for Boston Scientific; consultant for Olympus and Cook; lecturer for Olympus, Medtronic, Erbe, and Gore. T. Zuchelli: Consultant for Boston Scientific. C. Piraka: Research support from Aries and US Endoscopy. M. A. Khashab: Consultant for Boston Scientific, Medtronic, and Olympus. J. Sloan: Consultant for Medtronic. All. financial relationships.

Publisher Copyright:
© 2022 American Society for Gastrointestinal Endoscopy


  • Adult
  • Aged
  • Esophageal Achalasia
  • Esophageal Motility Disorders/etiology
  • Esophageal Sphincter, Lower/surgery
  • Female
  • Humans
  • Middle Aged
  • Natural Orifice Endoscopic Surgery/methods
  • Retrospective Studies
  • Treatment Outcome

PubMed: MeSH publication types

  • Journal Article


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