Baylor University Medical Center and Center for Esophageal Research, Baylor Scott & White Research Institute Dallas, TX
Jesse Zhang, BS1, Anh D. Nguyen, MD2, Roseann Mendoza, FNP1, Eitan Podgaetz, MD, MPH3, Rhonda F. Souza, MD2, Stuart J. Spechler, MD, FACG2, Vani Konda, MD, FACG2; 1Center for Esophageal Diseases, Baylor University Medical Center, Dallas, TX; 2Baylor University Medical Center and Center for Esophageal Research, Baylor Scott & White Research Institute, Dallas, TX; 3Center for Thoracic Surgery, Center for Esophageal Diseases, Baylor University Medical Center and Center for Esophageal Research, Baylor Scott & White Research Institute, Dallas, TX
Introduction: EsoFLIP is a novel technique for esophageal balloon dilation that uses impedance planimetry technology to provide real-time display of the diameter of the esophageal segment during dilation. The EsoFLIP balloon can reach a diameter of 30 mm, similar to pneumatic dilation balloons traditionally used to treat achalasia, but without the need for fluoroscopic positioning. We report our center’s experience with EsoFLIP for esophageal dilation. Methods: We performed a retrospective review of our center’s database to identify all patients who had esophageal dilation performed with the EsoFLIP balloon. Data were collected on patient clinical characteristics and symptom response. For achalasia treatment, a post dilation EGJ diameter of 16 mm at a 30 mL balloon fill volume was considered a technical success. Results: 46 patients (mean age 61 years, 18 male) had EsoFLIP dilations between December 2018 and February 2020. There were 26 surgery-naïve patients; 5 had achalasia (2 Type 2, 3 Type 3), 13 had EGJOO, and 8 had achalasia-like disorders with normal IRP but a low EGJ distensibility index by EndoFLIP. At the first follow-up visit, 20 of the 26 surgery-naïve patients (77%) reported symptomatic improvement with Eckardt scores falling from a mean of 5 to 2. Technical success was achieved in 20 of the 26 patients (77%) while the remaining patients had stepwise dilation due to patient preference or clinical judgement. Of those who had technical success, 15 of the 20 (75%) reported symptomatic improvement. There were 12 patients who had prior myotomy for achalasia (10 Heller myotomy with Dor fundoplication, 2 POEM); symptomatic improvement was reported by 8 patients (67%). There were 8 patients with dysphagia after anti-reflux surgery (4 Nissen fundoplication, 2 Dor fundoplication, 1 Toupet fundoplication, 1 Angelchik prosthesis); symptomatic improvement was reported by 5 patients (62%). Among all 46 patients, there was 1 perforation (2%) in a patient who had prior botulinum injection; the perforation was identified immediately and managed successfully with a stent. Discussion: EsoFLIP improved symptoms in approximately three-quarters of surgery-naïve patients and in two-thirds of patients with prior foregut surgery. The perforation rate (2%) was similar to that for pneumatic dilation. The ability to perform stepwise dilation and lack of need for fluoroscopy are advantages of EsoFLIP. Additional studies are needed to determine how it may be utilized as a stepwise approach in these patients.
Disclosures: Jesse Zhang indicated no relevant financial relationships. Anh Nguyen indicated no relevant financial relationships. Roseann Mendoza indicated no relevant financial relationships. Eitan Podgaetz indicated no relevant financial relationships. Rhonda Souza indicated no relevant financial relationships. Stuart Spechler: Interpace Diagnostics – Consultant. Ironwood Pharmaceuticals – Consultant. Phathom Pharmaceuticals – Consultant. UpToDate – Other Financial or Material Support, Topic author. Vani Konda indicated no relevant financial relationships.