The Utility of EndoFLIP in Individualizing POEM for Achalasia

Achalasia is characterized by a progressive loss of esophageal peristalsis and impaired relaxation of the lower esophageal sphincter resulting in dysphagia and regurgitation. Peroral endoscopic myotomy (POEM) is safe and effective option for managing achalasia although it is accompanied by moderate rates of reflux. One potential strategy to minimize reflux is to create shorter myotomies whilst ensuring adequate symptom relief. The Endoluminal Functional Lumen Imaging Probe uses high-resolution impedance planimetry to measure cross sectional surface area and pressure at points along the esophagus. The purpose of this chapter is to evaluate the evidence behind using impedance planimetry to customize myotomy length in POEM. There is evidence to suggest that the use of impedance planimetry improves outcomes in POEM. There also is evidence that shorter myotomies enabled by use of impedance planimetry are clinically effective and may be associated with reduced reflux rates.