Impact of Impedance Planimetry on Optimized Therapeutic Assessment in Complex Benign Esophageal Stenosis – A Prospective, Randomized Trial

Abstract Accurate evaluation of complex benign esophageal stenosis is essential for successful endoscopic dilation, yet conventional methods are either subjective or involve radiation exposure. This study investigated whether impedance planimetry (EndoFLIP) optimizes stricture geometry assessment compared with conventional nonradiographic methods and whether it improves patient outcomes. Totally 22 adult patients with symptomatic benign esophageal strictures were allocated to either a planimetry group or a control group. In the planimetry group, FLIP measurements were obtained before and after dilation in addition to standard endoscopic evaluation, whereas the control group underwent conventional assessment alone. Symptoms and quality of life were evaluated using the SWAL-QOL questionnaire pre- and 14 days postprocedure. EndoFLIP measurements revealed significant increases in diameter, cross-sectional area, and distensibility following dilation. Compared with FLIP, stricture length was underestimated endoscopically by an average of 14.4 mm and post-therapeutic diameter was overestimated by 1.2 mm based on the final dilator size. G-SWAL-QOL total scores improved in both groups, whereas symptom scores and tolerance of solid food improved significantly in the planimetry group only. The use of impedance planimetry enabled a standardized and radiation-free assessment of complex benign esophageal stenosis and may contribute to optimizing the treatment of complex benign strictures of the upper gastrointestinal tract.