Endoflip Hiatal Calibration During Anterior Partial Fundoplication – Early Outcomes

Leslie Nathanson, Dr. Wesley Hospital, Brisbane

Methods

Thirty one male and 57 female patients of mean age 54yr undergoing Anterior Partial Fundoplication had documentation of symptom score, Endoscopy and Oesophageal pH.  EndoFLIP assessment of the compliance of the hiatus was undertaken using the EF-325 catherer with 30ml fill. Baseline readings prior to repair were compared to control patients and intraoperative suturing calibrated using a variety of parameters (minimum diameter, cross sectional area (CSA) and distension index (Dind)). At six months follow up re-evaluation was undertaken with EndoFLIP assessment and oesopageal pH study, in addition to symptom score and Endoscopy.

A detailed presentation of the intra-operative deployment of the EndoFLIP catheter will highlight its accuracy and utility for evaluating hiatal compliance. 

Results

Hiatal EndoFLIP asessment of CSA was 58 mm² vs control 37mm² (p<0.0001) and Dind 2.8 vs control 1.3.

After intraoperative calibration to CSA 20mm2 and Dind of 0.8, six month follow up revealed CSA  37mm² (22 -51) and Dind 1.4 (1.1 – 2.8)  At six months 24hr distal oesophageal pH  of 0.2% (Normal < 4) with Demeester score of 1.2 (Normal < 14)

Conclusions

Thes data confirm the limited published information confirming increased hiatal compliance in patients with pathologic oesophageal reflux. In addition realtime EndoFLIP intraoperative monitoring of the hiatal repair and follow up data at 6 months gives a glimpse of the impact of the effect of healing. This tool shows promise for evaluating and standardising hiatal repair techniques.

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