Experience with Impedance Planimetry for Surgical Foregut Disease in 1097 Cases.

BACKGROUND: The geometry and compliance of gastrointestinal sphincters may be assessed by impedance planimetry using a functional lumen imaging probe (FLIP). We describe our institutional foregut surgeon experience utilizing FLIP in 1097 cases, highlighting instances where FLIP changed operative decision making.

STUDY DESIGN: A retrospective review of an IRB approved prospective quality database was performed. This included operative and endoscopic suite foregut procedures utilizing FLIP between February 2013 and May 2022.

RESULTS: During the study period, FLIP was utilized a total of 1097 times in 919 unique patients by two foregut surgeons. Intraoperative FLIP was used during 573 anti-reflux procedures and 272 endoscopic myotomies. FLIP was also used during 252 endoscopic suite procedures. For those undergoing preoperative workup of GERD, starting in 2021, esophageal panometry was performed in addition to standard FLIP measurements at the lower esophageal sphincter. In 77 cases, intraoperative FLIP changed operative decision making. During anti-reflux procedures, changes included adding or removing crural sutures, adjusting a fundoplication tightness, choice of full vs. partial wrap, and magnetic sphincter augmentation sizing. For endoscopic procedures, changes included aborting POEM or ZPOEM, performing a myotomy when preoperative diagnosis was unclear, or performing additional myotomy.

CONCLUSION: FLIP is a useful tool for assessing the upper esophageal sphincter, lower esophageal sphincter, pylorus, and secondary esophageal peristalsis that can be utilized in a wide variety of clinical situations within a foregut surgeons practice. It can also function as an adjunct in intraoperative decision making.