Functional Lumen Imaging Probe Panometry Helps Identify Clinically Relevant Esophagogastric Junction Outflow Obstruction per Chicago Classification v4.0

Carlson, Dustin A.; Schauer, Jacob M.; Kou, Wenjun; Kahrilas, Peter J.; Pandolfino, John E.

doi:10.14309/ajg.0000000000001980

Cited by 21 publications

(13 citation statements)

References 30 publications

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“…Multiple studies have demonstrated that EGJ distensibility is reduced in achalasia 20–23 . Additionally, several studies have demonstrated that evaluating EGJ distensibility/opening among patients with inconclusive achalasia or manometric EGJOO can help identify patients with a “conclusive” disorder of EGJ outflow, thus utilization of FLIP in this scenario was recommended by the CCv4.0 13,24–26 . Further, FLIP metrics of EGJ‐DI and maximum EGJ diameter, as well as an associated classification of EGJ opening, outperformed the IRP on HRM to predict abnormal retention on TBE 27 .…”

Section: Discussionmentioning

confidence: 99%

Relaxation of the lower esophageal sphincter in response to reduced volume distension during FLIP Panometry

Wakim El‐Khoury,

Pandolfino,

Kahrilas

et al. 2023

Neurogastroenterology Motil

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BackgroundThe esophageal response to stepwise distension during the functional lumen imaging probe (FLIP) Panometry study often parallels high‐resolution manometry (HRM) motility diagnoses. This study aimed to describe the changes in FLIP metrics during FLIP emptying, that is, reduced volume distension.MethodsAdult patients who completed FLIP and HRM for esophageal motility evaluation were included. Esophagogastric junction (EGJ) opening parameters were assessed during stepwise FLIP filling to volumes of 60 mL (“filling 60 mL”), then 70 mL, and then back to 60 mL (“emptying 60 mL”). HRM studies were analyzed per Chicago classification version 4.0 (CCv4.0).Key ResultsAmong 265 patients included, HRM/CCv4.0 diagnoses included achalasia in 80 patients (30%), normal motility in 70 (26%), and ineffective esophageal motility (IEM) in 43 (16%). EGJ‐distensibility index (DI) and EGJ diameter were greater during emptying 60 mL than filling 60 mL in achalasia, normal motility, and IEM (p values <0.002). If applying the emptying 60 mL EGJ‐DI (vs. filling 60 mL EGJ‐DI), EGJ opening classification changed from reduced EGJ opening to borderline EGJ opening in 31% of achalasia patients and in 2% of patients with normal motility or IEM. EGJ opening classification was unchanged in 69% achalasia and 96% of normal motility/IEM.Conclusions and InferencesThis study suggests that isotonic or auxotonic relaxation of the lower esophageal sphincter occurs with reduced volume distension in patients with achalasia and normal motility. The study also supports the importance of utilizing a standardized FLIP motility study protocol (i.e., controlled, stepwise filling to 50 mL, 60 mL, then 70 mL) to provide reliable and generalizable FLIP metrics to facilitate diagnosis of esophageal motility disorders.

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Section: Discussionmentioning

confidence: 99%

Relaxation of the lower esophageal sphincter in response to reduced volume distension during FLIP Panometry

Wakim El‐Khoury,

Pandolfino,

Kahrilas

et al. 2023

Neurogastroenterology Motil

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“…Eine FLIP-Manometrie kann helfen, klinisch relevante Abflussbehinderungen zu erfassen [30]. Die Untersuchung wird im Zusammenhang mit einer ÖGD beim sedierten Patienten durchgeführt.…”

Section: Functional Luminal Imaging Probe (Flip)unclassified

Motilitätsstörungen des Ösophagus – Was ist neu?

Keller

2023

Dtsch Med Wochenschr

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Im Extremfall können sich Patienten mit Ösophagus-Motilitätsstörungen nicht ausreichend ernährenund auch pulmologische Komplikationen kommen vor. Die Achalasie ist die wichtigste definierte Ösophagus-Motilitätsstörung. In den letzten 10-15 Jahren gewann man neue Erkenntnisse zur Pathophysiologie; und neue diagnostische und therapeutische Verfahren ermöglichen nun eine frühere Erkennung und zielgenauere Therapie dieser und anderer Ösophagus-Motilitätsstörungen.

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“…Other alternatives for determining the clinical relevance of EGJOO exist. FLIP measuring distensibility of the LES appears to be an accurate tool to identify clinically relevant EGJOO, when assessed against longitudinal clinical outcomes 50 . Provocative testing during manometry using larger volumes of water (rapid drink challenge) or solid food to more closely replicate normal eating and drinking behavior can help clarify the significance of manometric EGJOO.…”

Section: Utility Of Barium Esophagography Alongside Other Esophageal ...mentioning

confidence: 99%

“…FLIP measuring distensibility of the LES appears to be an accurate tool to identify clinically relevant EGJOO, when assessed against longitudinal clinical outcomes. 50 Provocative testing during manometry using larger volumes of water (rapid drink challenge)…”

Section: (A) (B)mentioning

confidence: 99%

“…Cumulatively, the limited evidence suggests that a TBS that demonstrates esophageal retention of barium, even at 1 min, is predictive of clinically relevant EGJOO and can be used to support a decision to offer achalasia-type therapy, while a "normal" TBS (i.e., complete esophageal emptying) does not rule out clinically significant obstruction. In such situations further testing, whether by provocative manometric testing or FLIP, 50,52 should be undertaken to ensure that treatable obstruction is not missed.…”

Section: (A) (B)mentioning

confidence: 99%

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How to effectively use and interpret the barium swallow: Current role in esophageal dysphagia

Sanagapalli

Plumb

Lord

et al. 2023

Neurogastroenterology Motil

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BackgroundThe barium swallow is a commonly performed investigation, though recent decades have seen major advances in other esophageal diagnostic modalities.PurposeThe purpose of this review is to clarify the rationale for components of the barium swallow protocol, provide guidance on interpretation of findings, and describe the current role of the barium swallow in the diagnostic paradigm for esophageal dysphagia in relation to other esophageal investigations. The barium swallow protocol, interpretation, and reporting terminology are subjective and non‐standardized. Common reporting terminology and an approach to their interpretation are provided. A timed barium swallow (TBS) protocol provides more standardized assessment of esophageal emptying but does not evaluate peristalsis. Barium swallow may have higher sensitivity than endoscopy for detecting subtle strictures. Barium swallow has lower overall accuracy than high‐resolution manometry for diagnosing achalasia but can help secure the diagnosis in cases of equivocal manometry. TBS has an established role in objective assessment of therapeutic response in achalasia and helps identify the cause of symptom relapse. Barium swallow has a role in the evaluating manometric esophagogastric junction outflow obstruction, in some cases helping to identify where it represents an achalasia‐like syndrome. Barium swallow should be performed in dysphagia following bariatric or anti‐reflux surgery, to assess for both structural and functional postsurgical abnormality. Barium swallow remains a useful investigation in esophageal dysphagia, though its role has evolved due to advancements in other diagnostics. Current evidence‐based guidance regarding its strengths, weaknesses, and current role are described in this review.

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Functional Lumen Imaging Probe Panometry Helps Identify Clinically Relevant Esophagogastric Junction Outflow Obstruction per Chicago Classification v4.0

Cited by 21 publications

References 30 publications

Relaxation of the lower esophageal sphincter in response to reduced volume distension during FLIP Panometry

Relaxation of the lower esophageal sphincter in response to reduced volume distension during FLIP Panometry

Motilitätsstörungen des Ösophagus – Was ist neu?

How to effectively use and interpret the barium swallow: Current role in esophageal dysphagia

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