Lester Tsai, MD, David Kunkel, MD; University of California San Diego, San Diego, CA
Introduction: EsoFLIP is a type of pneumatic balloon dilation that utilizes impedance planimetry to carry out volume-controlled distension. Given that there is no pressure sensor within the instrument, a common approach to dilation is to expand the balloon until the waist is eliminated. This study investigates factors associated with outcomes of this approach. Methods: We conducted a retrospective review of 30 consecutive patients who underwent EsoFLIP dilation with propofol anesthesia and post-dilation esophagram between May 2017 to March 2020. Baseline demographics and relevant past medical history were recorded. Data collected from EsoFLIP procedures included indication, maximum volume inflated, and maximum diameter achieved. A dilation was considered effective if the patient reported symptomatic improvement of dysphagia by at least 50% for more than 3 months. Results: A total of 33 EsoFLIP procedures were performed among 30 patients. No perforations occurred. Indications for the procedure included dysphagia post-fundoplication, achalasia, and stricture. Twenty dilations were successful and 13 were unsuccessful. Comparing the successful vs unsuccessful dilations, no significant difference was noted in the maximum volume inflated (54.2 mL versus 51.2 mL, p = 0.38); however, there was a statistically significant difference in the maximum diameter achieved (24.9 mm versus 22.3 mm, p = 0.05). Fourteen of the 33 EsoFLIP dilations were performed on patients with a diagnosis of achalasia. Within this cohort, 83% of dilations were successful and consisted of all patients with subtypes 1 and 2. Unsuccessful dilations only occurred with subtype 3. Mean length of follow-up for all 30 patients was 7.6 months. Discussion: This study identifies significant factors associated with the success of an EsoFLIP dilation. While all patients underwent dilations with elimination of the waist, outcomes were better with larger dilations up to 25 mm. This finding suggests that this may be a diameter to target in order to boost EsoFLIP efficacy, regardless of the balloon’s geometry. Additionally, this data shows that the achalasia subtype 3 often experienced unsuccessful FLIP dilations, compared to patients with subtypes 1 or 2. As more data becomes available, studies such as this will have an impact on evolving treatment strategies with EsoFLIP.
Baseline characteristics and study findings.
Disclosures: Lester Tsai indicated no relevant financial relationships. David Kunkel indicated no relevant financial relationships.