Author: CAMPANALE Mariachiara Genova Italy

Not every patient with persistent symptoms after POEM needs another intervention. And sometimes, the most important therapeutic decision is knowing when not to treat. Today we performed two very different but equally instructive cases using EndoFLIP technology for functional assessment of the esophagus.

Case 1

A patient treated with POEM in 2025 still presented with symptoms one year later and a significantly dilated esophagus.

However, EndoFLIP showed adequate EGJ distensibility and normal diameters. No additional dilation. No extension of the myotomy.

Why? Because further treatment could have exposed the patient to pathological reflux without providing real benefit.

Case 2

A challenging Type III achalasia treated with POEM, with EndoFLIP performed before and after the procedure.

Seeing the immediate change in EGJ dynamics after myotomy is a powerful reminder of how physiology can now guide therapeutic endoscopy in real time.

We often focus on anatomy. But modern third-space endoscopy is increasingly about function, precision, and tailored decision-making.

EndoFLIP is helping us move from "treating images" to truly understanding esophageal physiology during the procedure itself.

Proud to continue growing our experience in advanced functional and third-space endoscopy at E.O. Ospedali Galliera - Genoa