Esophagogastric junction distensibility in the management of achalasia patients: relation to treatment outcome

Abstract

Assessment of EGJ distensibility with the EndoFLIP technique is able to demonstrate the functional EGJ obstruction in newly diagnosed achalasia patients and EGJ distensibility differs between achalasia subtypes. Although PD improves EGJ distensibility, assessment of EGJ distensibility with a limited number of distension steps provides no additional information that is useful for clinical evaluation and management of achalasia patients.

Esophagogastric junction distensibility identifies achalasia subgroup with manometrically normal esophagogastric junction relaxation

“…This study shows that a subgroup of patients with clinical and radiological features of achalasia, but manometrically normal EGJ relaxation, has an impaired EGJ distensibility at EndoFLIP measurements. The impaired EGJ distensibility, which is also seen in achalasia patients with manometric dysrelaxation of the EGJ, explains the discrepancy between the clinical and radiological features of achalasia and the apparently normal EGJ relaxation on HRM. This finding supports our hypothesis that these patients actually suffer from achalasia.…”

“…Measuring the distensibility of the EGJ gives a more direct view of the EGJ function compared to the IRP. Previous studies showed that in treatment naïve achalasia patients with manometrically incomplete EGJ relaxation, the EGJ distensibility is clearly impaired compared to healthy subjects . Therefore, we hypothesized that in this subgroup of patients the EGJ distensibility is reduced which explains the discrepancy between the clinical and radiological features and the apparently normal EGJ relaxation on HRM.…”

Evaluation of Esophageal Motility Utilizing the Functional Lumen Imaging Probe

“…The distensibility of the esophagogastric junction (EGJ) is assessed by a metric termed the EGJ distensibility index (DI), which was demonstrated to be abnormally low in treatment-naïve achalasia. (2-4) Distension-mediated contractility was reported in initial studies utilizing esophageal impedance planimetry and later observed as a complicating factor during FLIP-distensibility assessment of the esophageal body in eosinophilic esophagitis. (5-8) However, by employing customized software to generate FLIP topography plots, organized patterns of distension-associated contractions were identified.…”

Emerging Roles of the Endolumenal Functional Lumen Imaging Probe in Gastrointestinal Motility Disorders

“…18 EndoFLIP also detects esophageal contractility that is not observed with manometry in achalasia 19 and may in future be useful in subtyping of achalasia. 20 We propose that a distensibility of ≤ 1 mm 2 /mmHg and a diameter ≤ 5 mm as cut-offs for the need of dilation or peroral endoscopic myotomy (POEM) or myotomy (Table). Distensibility of the EGJ was found to increase following pneumatic dilation 20 but a successful outcome may require that the dilation achieves a higher distensibility than that found in normal subjects due to incompetent motility in this group of patients.…”

“…20 We propose that a distensibility of ≤ 1 mm 2 /mmHg and a diameter ≤ 5 mm as cut-offs for the need of dilation or peroral endoscopic myotomy (POEM) or myotomy (Table). Distensibility of the EGJ was found to increase following pneumatic dilation 20 but a successful outcome may require that the dilation achieves a higher distensibility than that found in normal subjects due to incompetent motility in this group of patients. 21,22 Familiari et al 23 studied the utility of EndoFLIP in patients who underwent POEM for achalasia and found a substantial post-POEM increases in the diameter and CSA of the EGJ.…”