J Neurogastroenterol Motil  https://doi.org/10.5056/jnm22016
Usefulness of EndoFLIP in diverticular peroral endoscopic myotomy for symptomatic epiphrenic diverticulum
Jin Hee Noh, Do Hoon Kim, Kee Wook Jung, Hee Kyong Na, Ji Yong Ahn, Jeong, Hoon Lee, Kee Don Choi, Ho June Song, Gin Hyug Lee, and Hwoon-Yong Jung
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Correspondence to: Do Hoon Kim, MD, PhD
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
Tel: +82-2-3010-3193, Fax: +82-2-476-0824, E-mail: dohoon.md@gmail.com
Received: February 2, 2022; Revised: June 10, 2022; Accepted: July 3, 2022; Published online: December 26, 2022
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

Abstract
Background/Aims
Diverticular peroral endoscopic myotomy (D-POEM) is known to be a safe and feasible technique for managing diverticular diseases of the esophagus. In this study, we aimed to report our experience with D-POEM and to investigate the usefulness of EndoFLIP in determining the need for cardiomyotomy with septotomy for symptomatic epiphrenic diverticulum.
Methods
Consecutive patients who underwent D-POEM for symptomatic epiphrenic diverticulum between September 2019 and September 2021 were eligible for this study. EndoFLIP and high-resolution manometry (HRM) results and endoscopic treatment outcomes were retrospectively investigated.
Results
A total of 9 patients with symptomatic epiphrenic diverticulum were included. The median size of the diverticulum and septum was 50 (interquartile range [IQR], 48-80) mm and 20 (IQR, 20-30) mm, respectively. The overall technical success rate was 100%, with a median procedure time of 60 (IQR, 46-100) min. The 5 patients (HRM results; 3 normal, 1 ineffective esophageal motililty, and 1 Jackhammer esophagus) who had decreased esophagogastric junction distensibility index (DI) on pre-procedure EndoFLIP underwent cardiomyotomy with septotomy regardless of the presence of esophageal motility disorders, and the DI increased and normalized after procedure. The mean dysphagia score decreased from 2.0 ± 1.0 pre-procedure to 0.4 ± 0.7 during a median follow-up of 11 (IQR, 4-21) months post-procedure. No serious adverse events that required surgical intervention or delayed discharge were noted.
Conclusions
EndoFLIP may help decide whether to perform combined cardiomyotomy and septotomy for the treatment of an epiphrenic diverticulum. Further large-scale studies are needed to confirm these results.
Keywords: Diverticular POEM; EndoFLIP; Esophageal diverticulum; Peroral endoscopic myotomy

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