Endoscopic functional luminal imaging probe for intraprocedural guidance of achalasia treatment: a systematic review and meta-analysis.

Abstract

Background: Functional luminal imaging probes (EndoFLIP) have shown potential as both diagnostic tools and intraoperative guides during achalasia interventions. This systematic review and meta-analysis aim to evaluate the intraoperative use of EndoFLIP during surgical procedures for achalasia, with a focus on its impact on the distensibility index (DI) and treatment outcomes.

Materials and methods: A literature search of Medline, Embase, and the Cochrane Library was conducted for studies reporting the use of EndoFLIP and DI in achalasia treatment from January 2000 to January 2024. Meta-analysis was performed using random-effect models to assess treatment effects, with heterogeneity between studies evaluated.

Results: A total of 32 studies with 2,681 patients were included in the qualitative synthesis, and 17 studies with 1,734 patients were included in the quantitative synthesis. A pooled random-effects analysis demonstrated a significant reduction in DI following myotomy, with a weighted mean difference (WMD) of -3.72 (95% CI -4.16 to -3.28; I2 = 90%). The Eckardt score analysis, including data from 1,009 patients, showed a significant reduction by -5.21 (95% CI -5.8 to -4.6; p < 0.001, I2 = 89.4%). The random-effects analysis of DI pre- and post-myotomy without an endoscope demonstrated a significant increase with a WMD of -2.402 (95% CI -3.175 to -1.6; p < 0.001, I2 = 85.6%). A larger WMD was observed with endoscope placement above the FLIP device, measuring -4.14 (95% CI -5.4 to -2.8; p < 0.001, I2 = 91.2%). For the 30 mL balloon fill, the weighted mean difference (WMD) in the distensibility index (DI) post-myotomy was -2.89 (95% CI -3.2 to -2.4; p < 0.001). For the 40 mL balloon fill, the WMD was -4.02 (95% CI -4.8 to -3.1; p < 0.001).

Conclusions: EndoFLIP enhances achalasia treatment by offering real-time feedback on the distensibility index, allowing for more tailored interventions and improved outcomes. A standardized protocol for EndoFLIP usage is necessary to further validate its role in clinical practice and ensure consistent, comparable measurements.