The Use of Intraoperative Esophageal Functional Luminal Imaging Probe for Prediction of Therapeutic Outcomes in Achalasia Patients.

c 2023 The Korean Society of Neurogastroenterology and Motility J Neurogastroenterol Motil, Vol. 29 No. 3 July, 2023 www.jnmjournal.org TO THE EDITOR: With great interest, we read the article of Hsing et al The authors assessed correlation of the diagnostic parameters of functional luminal imaging probe (FLIP) panometry and high-resolution manometry and Eckardt scores. Those parameters were compared before and after peroral endoscopic myotomy (POEM), and those changes were differentially revealed that the patients who showed repetitive antegrade contraction (RAC) and/or diagnosed as achalasia II before POEM were most likely resulted in presence of contractility (POC), a normal contractile response to sustained esophageal distension. A total of 68 achalasia patients underwent POEM were monitored upon measurements as shown in Table 1. Pre-POEM, those patients had similarities in Eckardt score and FLIP motility esophagogastric junction–distensibility index (EGJ-DI) compared in 3 subtypes of achalasia; post-POEM in follow-up 36 patients, Eckardt score was overall achieved < 3 (P < 0.01), integrated relaxation pressure was decreased to < 15 mmHg (P < 0.01) and EGJ-DI > 8 (P < 0.01). Authors obtained a good efficacy of POEM in consistent to other studies. However, all of those cannot be for prediction in correlative to POEM efficacy. Thus, Hsing et al suggested that the POC is one of critical indexes reflecting a good restoration of motility function of lower esophagus sphincter, which was seen in 8%, 67%, and 25% respectively from type-I, -II, and -III achalasia after POEM, ie, there is a better expectation from POEM in achalasia subtype II than I or III. Furthermore, the POC was absolutely not seen when RAC(–), and all other important parameters indicating improvement changes do not correlate to POC as shown in Table