Validation of Clinically Relevant Thresholds of Esophagogastric Junction Obstruction Using FLIP Panometry

Dustin A. Carlson*, Jacqueline E. Prescott, Alexandra J. Baumann, Jacob M. Schauer, Amanda Krause, Erica N. Donnan, Wenjun Kou, Peter J. Kahrilas, John E. Pandolfino

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

35 Scopus citations

Abstract

Background & Aims: This study aimed to assess the accuracy of functional luminal imaging probe (FLIP) panometry to detect esophagogastric junction (EGJ) obstruction assigned by high-resolution manometry (HRM) and the Chicago Classification version 4.0 (CCv4.0). Methods: Six hundred eighty-seven adult patients who completed FLIP and HRM for primary esophageal motility evaluation and 35 asymptomatic volunteers (controls) were included. EGJ opening was evaluated with 16-cm FLIP during sedated endoscopy via EGJ-distensibility index (DI) and maximum EGJ diameter. HRM was classified according to CCv4.0 and focused on studies with a conclusive disorder of EGJ outflow (ie, achalasia subtypes I, II, or III; or EGJ outflow obstruction with abnormal timed barium esophagogram) or normal EGJ outflow. Results: All 35 controls had EGJ-DI >3.0 mm2/mmHg and maximum EGJ diameter >16 mm. Per HRM and CCv4.0, 245 patients had a conclusive disorder of EGJ outflow, and 314 patients had normal EGJ outflow. Among the 241 patients with reduced EGJ opening (EGJ-DI <2.0 mm2/mmHg and maximum EGJ diameter <12 mm) on FLIP panometry, 86% had a conclusive disorder of EGJ outflow per CCv4.0. Among the 203 patients with normal EGJ opening (EGJ-DI ≥2.0 mm2/mmHg and maximum EGJ diameter ≥16 mm) on FLIP panometry, 99% had normal EGJ outflow per CCv4.0. Conclusions: FLIP panometry accurately identified clinically relevant conclusive EGJ obstruction as defined by CCv4.0 in patients evaluated for esophageal motor disorders. Thus, FLIP panometry is a valuable tool for both independent and complementary evaluation of esophageal motility.

Original languageEnglish (US)
Pages (from-to)e1250-e1262
JournalClinical Gastroenterology and Hepatology
Volume20
Issue number6
DOIs
StatePublished - Jun 2022

Funding

Funding Supported by P01 DK117824 (JEP) from the Public Health Service and American College of Gastroenterology Junior Faculty Development Award (DAC). Funding Supported by P01 DK117824 (JEP) from the Public Health Service and American College of Gastroenterology Junior Faculty Development Award (DAC). Conflicts of interest These authors disclose the following: JEP, PJK, and Northwestern University hold shared intellectual property rights and ownership surrounding FLIP Panometry systems, methods, and apparatus with Medtronic Inc. DAC: Medtronic (Speaking, Consulting). PJK: Ironwood (Consulting); Reckitt Benckiser (Consulting). JEP: Crospon, Inc (stock options), Given Imaging (Consulting, Grant, Speaking), Sandhill Scientific (Consulting, Speaking), Takeda (Speaking), Astra Zeneca (Speaking), Medtronic (Speaking. Consulting), Torax (Speaking, Consulting), Ironwood (Consulting), Impleo (Grant). The remaining authors disclose no conflicts.

Keywords

  • Dysphagia
  • Impedance
  • Reflux

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

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