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. 2025 Aug 6.
doi: 10.1007/s00464-025-12030-7. Online ahead of print.

Can intraoperative impedance planimetry (EndoFLIP™) during anti-reflux surgery replace preoperative manometry with no difference in patient outcomes?

Jean-Christophe N Rwigema  1   2 , Derrius Anderson  3 , Sullivan A Ayuso  3 , Jonathan Chao  3 , Kristine Kuchta  3 , JoAnn Carbray  3 , H Mason Hedberg  3 , Michael B Ujiki  3
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Can intraoperative impedance planimetry (EndoFLIP™) during anti-reflux surgery replace preoperative manometry with no difference in patient outcomes?

Jean-Christophe N Rwigema et al. Surg Endosc. .

Abstract

Introduction: The advent of functional lumen imaging probe (FLIP) and panometry provides an additional means of evaluating esophageal motility in addition to conventional manometry. Beginning in 2022, our group began preferentially utilizing intraoperative panometry for anti-reflux operations to improve patient comfort and efficiency of access. This study aims to explore the changes in peri-operative and postoperative outcomes since implementing intraoperative FLIP panometry to evaluate esophageal motility.

Objective: The purpose of this project is to determine the changes in perioperative and postoperative outcomes since the implementation of intraoperative impedance panometry in place of preoperative manometry prior to patients undergoing anti-reflux procedures.

Methods: A retrospective review of a prospectively maintained gastroesophageal database was performed. Outcomes were analyzed of those patients from 2019 to 2024 undergoing Nissen fundoplication, Toupet fundoplication, magnetic sphincter augmentation, and anti-reflux mucosectomy. Our intraoperative panometry protocol was instituted in January of 2022. The groups were analyzed and compared using chi-square and Wilcoxon rank-sum tests.

Results: Between 2019 and 2024, 565 patients underwent anti-reflux interventions. Median follow-up after implementation of intraoperative panometry was three months, compared to 23 months in the manometry group. In the manometry group, 71.6% of patients had normal esophageal motility compared to 93.2% of patients in the panometry group (p < 0.0001). At 3 weeks, the panometry group had worse GERD-HRQL (p = 0.03) and worse gas bloat (p < 0.004) compared to the manometry group. At 6 months, 1 and 2 years, there were no differences in RSI, GERD-HRQL, gas bloat or dysphagia scores between the groups.

Conclusions: It is reasonable to forego preoperative manometry in favor of intraoperative FLIP panometry for anti-reflux procedures. There is no difference in patient quality of life outcomes at 6 months and 1 year post-operatively.

Keywords: Anti-reflux; FLIP panometry; Impedance panometry; Interventions; Manometry.

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Conflict of interest statement

Declarations. Disclosures: The principal investigator, Michael B. Ujiki is a scientific advisory board member for Boston Scientific and Apollo, a consultant and speaker for WL Gore and Associates, and a speaker for Medtronic. Jean-Christophe Rwigema, Derrius J. Anderson, Sullivan Ayuso, Jonathan Chao, Kristine Kuchta, JoAnn Carbray, and H. Mason Hedberg all have no financial interests or conflicts of interest to disclose.

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