Evidence map›Paper›PMID 40770509›Full record

ArticleSurgical endoscopy2025

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

Jean-Christophe N Rwigema, Derrius Anderson, Sullivan A Ayuso, Jonathan Chao, Kristine Kuchta, JoAnn Carbray, H Mason Hedberg, Michael B Ujiki

Abstract read
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In one paragraph

Article in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Guideline
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Jean-Christophe N RwigemaDivision of Gastrointestinal and General Surgery, Department of Surgery, Endeavor Health, Evanston, IL, USA. jchrisrwigema@gmail.com.
Derrius AndersonDivision of Gastrointestinal and General Surgery, Department of Surgery, Endeavor Health, Evanston, IL, USA.
Sullivan A AyusoDivision of Gastrointestinal and General Surgery, Department of Surgery, Endeavor Health, Evanston, IL, USA.
Jonathan ChaoDivision of Gastrointestinal and General Surgery, Department of Surgery, Endeavor Health, Evanston, IL, USA.
Kristine KuchtaDivision of Gastrointestinal and General Surgery, Department of Surgery, Endeavor Health, Evanston, IL, USA.
JoAnn CarbrayDivision of Gastrointestinal and General Surgery, Department of Surgery, Endeavor Health, Evanston, IL, USA.
H Mason HedbergDivision of Gastrointestinal and General Surgery, Department of Surgery, Endeavor Health, Evanston, IL, USA.
Michael B UjikiDivision of Gastrointestinal and General Surgery, Department of Surgery, Endeavor Health, Evanston, IL, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionThe 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.

objectiveThe 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.

methodsA 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.

resultsBetween 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.

conclusionsIt 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.

Indexed as

FundoplicationGastroesophageal RefluxManometryMonitoring, IntraoperativeAdultAgedElectric ImpedanceFemaleHumansMaleMiddle AgedPostoperative ComplicationsPreoperative CareRetrospective StudiesTreatment OutcomeAnti-refluxFLIP panometryImpedance panometryInterventionsManometry

Identifiers

PMID40770509

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.