Impedance planimetry values for predicting clinical response following peroral endoscopic myotomy

Robert A. Moran; Olaya I. Brewer Gutierrez; Burkhard Rahden; Kenneth Chang; Michael Ujiki; In Kyung Yoo; Shraddha Gulati; John Romanelli; Mohammed Al-Nasser; Toshitaka Shimizu; Mason H. Hedberg; Joo Young Cho; Bu Hayee; David Desilets; Jörg Filser; Kyle Fortinsky; Amyn Haji; Lea Fayad; Omid Sanaei; Mohamad Dbouk; Vivek Kumbhari; Bethany J. Wolf; B. Joseph Elmunzer; Mouen A. Khashab

doi:10.1055/a-1268-7713

Impedance planimetry values for predicting clinical response following peroral endoscopic myotomy

Robert A. Moran, Olaya I. Brewer Gutierrez, Burkhard Rahden, Kenneth Chang, Michael Ujiki, In Kyung Yoo, Shraddha Gulati, John Romanelli, Mohammed Al-Nasser, Toshitaka Shimizu, Mason H. Hedberg, Joo Young Cho, Bu Hayee, David Desilets, Jörg Filser, Kyle Fortinsky, Amyn Haji, Lea Fayad, Omid Sanaei, Mohamad DboukVivek Kumbhari, Bethany J. Wolf, B. Joseph Elmunzer, Mouen A. Khashab

Gastroenterology and Hepatology

Research output: Contribution to journal › Article › peer-review

Abstract

Background: There is growing interest in developing impedance planimetry as a tool to enhance the clinical outcomes for endoscopic and surgical management of achalasia. The primary aim of this study was to determine whether impedance planimetry measurements can predict clinical response and reflux following peroral endoscopic myotomy (POEM). Methods: A multicenter cohort study of patients with achalasia undergoing POEM was established from prospective databases and retrospective chart reviews. Patients who underwent impedance planimetry before and after POEM were included. Clinical response was defined as an Eckardt score of ≤3. Tenfold cross-validated area under curve (AUC) values were established for the different impedance planimetry measurements associated with clinical response and reflux development. Results: Of the 290 patients included, 91.7% (266/290) had a clinical response and 39.4% (108/274) developed reflux following POEM. The most predictive impedance planimetry measurements for a clinical response were: percent change in cross-sectional area (%ΔCSA) and percent change in distensibility index (%ΔDI), with AUCs of 0.75 and 0.73, respectively. Optimal cutoff values for %ΔCSA and %ΔDI to determine a clinical response were a change of 360% and 272%, respectively. Impedance planimetry values were much poorer at predicting post-POEM reflux, with AUCs ranging from 0.40 to 0.62. Conclusion: Percent change in CSA and distensibility index were the most predictive measures of a clinical response, with a moderate predictive ability. Impedance planimetry values for predicting reflux following POEM showed weak predictive capacity.

Original language	English (US)
Pages (from-to)	570-577
Number of pages	8
Journal	Endoscopy
Volume	53
Issue number	6
DOIs	https://doi.org/10.1055/a-1268-7713
State	Published - Jun 1 2021

ASJC Scopus subject areas

Gastroenterology

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10.1055/a-1268-7713

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Moran, R. A., Brewer Gutierrez, O. I., Rahden, B., Chang, K., Ujiki, M., Yoo, I. K., Gulati, S., Romanelli, J., Al-Nasser, M., Shimizu, T., Hedberg, M. H., Cho, J. Y., Hayee, B., Desilets, D., Filser, J., Fortinsky, K., Haji, A., Fayad, L., Sanaei, O., ... Khashab, M. A. (2021). Impedance planimetry values for predicting clinical response following peroral endoscopic myotomy. Endoscopy, 53(6), 570-577. https://doi.org/10.1055/a-1268-7713

Moran, RA, Brewer Gutierrez, OI, Rahden, B, Chang, K, Ujiki, M, Yoo, IK, Gulati, S, Romanelli, J, Al-Nasser, M, Shimizu, T, Hedberg, MH, Cho, JY, Hayee, B, Desilets, D, Filser, J, Fortinsky, K, Haji, A, Fayad, L, Sanaei, O, Dbouk, M, Kumbhari, V, Wolf, BJ, Elmunzer, BJ & Khashab, MA 2021, 'Impedance planimetry values for predicting clinical response following peroral endoscopic myotomy', Endoscopy, vol. 53, no. 6, pp. 570-577. https://doi.org/10.1055/a-1268-7713

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title = "Impedance planimetry values for predicting clinical response following peroral endoscopic myotomy",

abstract = "Background: There is growing interest in developing impedance planimetry as a tool to enhance the clinical outcomes for endoscopic and surgical management of achalasia. The primary aim of this study was to determine whether impedance planimetry measurements can predict clinical response and reflux following peroral endoscopic myotomy (POEM). Methods: A multicenter cohort study of patients with achalasia undergoing POEM was established from prospective databases and retrospective chart reviews. Patients who underwent impedance planimetry before and after POEM were included. Clinical response was defined as an Eckardt score of ≤3. Tenfold cross-validated area under curve (AUC) values were established for the different impedance planimetry measurements associated with clinical response and reflux development. Results: Of the 290 patients included, 91.7% (266/290) had a clinical response and 39.4% (108/274) developed reflux following POEM. The most predictive impedance planimetry measurements for a clinical response were: percent change in cross-sectional area (%ΔCSA) and percent change in distensibility index (%ΔDI), with AUCs of 0.75 and 0.73, respectively. Optimal cutoff values for %ΔCSA and %ΔDI to determine a clinical response were a change of 360% and 272%, respectively. Impedance planimetry values were much poorer at predicting post-POEM reflux, with AUCs ranging from 0.40 to 0.62. Conclusion: Percent change in CSA and distensibility index were the most predictive measures of a clinical response, with a moderate predictive ability. Impedance planimetry values for predicting reflux following POEM showed weak predictive capacity.",

author = "Moran, {Robert A.} and {Brewer Gutierrez}, {Olaya I.} and Burkhard Rahden and Kenneth Chang and Michael Ujiki and Yoo, {In Kyung} and Shraddha Gulati and John Romanelli and Mohammed Al-Nasser and Toshitaka Shimizu and Hedberg, {Mason H.} and Cho, {Joo Young} and Bu Hayee and David Desilets and J{\"o}rg Filser and Kyle Fortinsky and Amyn Haji and Lea Fayad and Omid Sanaei and Mohamad Dbouk and Vivek Kumbhari and Wolf, {Bethany J.} and Elmunzer, {B. Joseph} and Khashab, {Mouen A.}",

year = "2021",

month = jun,

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doi = "10.1055/a-1268-7713",

language = "English (US)",

volume = "53",

pages = "570--577",

journal = "Endoscopy",

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TY - JOUR

T1 - Impedance planimetry values for predicting clinical response following peroral endoscopic myotomy

AU - Moran, Robert A.

AU - Brewer Gutierrez, Olaya I.

AU - Rahden, Burkhard

AU - Chang, Kenneth

AU - Ujiki, Michael

AU - Yoo, In Kyung

AU - Gulati, Shraddha

AU - Romanelli, John

AU - Al-Nasser, Mohammed

AU - Shimizu, Toshitaka

AU - Hedberg, Mason H.

AU - Cho, Joo Young

AU - Hayee, Bu

AU - Desilets, David

AU - Filser, Jörg

AU - Fortinsky, Kyle

AU - Haji, Amyn

AU - Fayad, Lea

AU - Sanaei, Omid

AU - Dbouk, Mohamad

AU - Kumbhari, Vivek

AU - Wolf, Bethany J.

AU - Elmunzer, B. Joseph

AU - Khashab, Mouen A.

PY - 2021/6/1

Y1 - 2021/6/1

N2 - Background: There is growing interest in developing impedance planimetry as a tool to enhance the clinical outcomes for endoscopic and surgical management of achalasia. The primary aim of this study was to determine whether impedance planimetry measurements can predict clinical response and reflux following peroral endoscopic myotomy (POEM). Methods: A multicenter cohort study of patients with achalasia undergoing POEM was established from prospective databases and retrospective chart reviews. Patients who underwent impedance planimetry before and after POEM were included. Clinical response was defined as an Eckardt score of ≤3. Tenfold cross-validated area under curve (AUC) values were established for the different impedance planimetry measurements associated with clinical response and reflux development. Results: Of the 290 patients included, 91.7% (266/290) had a clinical response and 39.4% (108/274) developed reflux following POEM. The most predictive impedance planimetry measurements for a clinical response were: percent change in cross-sectional area (%ΔCSA) and percent change in distensibility index (%ΔDI), with AUCs of 0.75 and 0.73, respectively. Optimal cutoff values for %ΔCSA and %ΔDI to determine a clinical response were a change of 360% and 272%, respectively. Impedance planimetry values were much poorer at predicting post-POEM reflux, with AUCs ranging from 0.40 to 0.62. Conclusion: Percent change in CSA and distensibility index were the most predictive measures of a clinical response, with a moderate predictive ability. Impedance planimetry values for predicting reflux following POEM showed weak predictive capacity.

AB - Background: There is growing interest in developing impedance planimetry as a tool to enhance the clinical outcomes for endoscopic and surgical management of achalasia. The primary aim of this study was to determine whether impedance planimetry measurements can predict clinical response and reflux following peroral endoscopic myotomy (POEM). Methods: A multicenter cohort study of patients with achalasia undergoing POEM was established from prospective databases and retrospective chart reviews. Patients who underwent impedance planimetry before and after POEM were included. Clinical response was defined as an Eckardt score of ≤3. Tenfold cross-validated area under curve (AUC) values were established for the different impedance planimetry measurements associated with clinical response and reflux development. Results: Of the 290 patients included, 91.7% (266/290) had a clinical response and 39.4% (108/274) developed reflux following POEM. The most predictive impedance planimetry measurements for a clinical response were: percent change in cross-sectional area (%ΔCSA) and percent change in distensibility index (%ΔDI), with AUCs of 0.75 and 0.73, respectively. Optimal cutoff values for %ΔCSA and %ΔDI to determine a clinical response were a change of 360% and 272%, respectively. Impedance planimetry values were much poorer at predicting post-POEM reflux, with AUCs ranging from 0.40 to 0.62. Conclusion: Percent change in CSA and distensibility index were the most predictive measures of a clinical response, with a moderate predictive ability. Impedance planimetry values for predicting reflux following POEM showed weak predictive capacity.

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JO - Endoscopy

JF - Endoscopy

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ER -

Impedance planimetry values for predicting clinical response following peroral endoscopic myotomy

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