Su1838 Esophageal Compliance Parameters Assessed With the Functional Lumen Imaging Probe (FLIP) Among Eosinophilic Esophagitis (EoE) Phenotypes

Background: In this study, we quantify the work done by the esophagus to open the esophagogastric junction (EGJ) and create a passage for bolus flow into the stomach. Work done on the EGJ was computed using functional lumen imaging probe (FLIP) panometry. Methods: Eighty-five individuals underwent FLIP panometry with a 16 cm catheter during sedated endoscopy including asymptomatic controls (n=15), 45 achalasics (n=15 each, three subtypes), GERD (n=13), eosinophilic esophagitis (EoE; n=8) and systemic sclerosis (SSc; n=5). Luminal CSA and pressure were measured by the FLIP catheter positioned across the EGJ. Work done on the EGJ (EGJW) was computed (millijoules, mJ) at 40 mL distension. Additionally, a separate method was developed to estimate the "work required" to fully open the EGJ (EGJROW) when it did not open during the procedure. Results: EGJW for controls had a median (IQR) value of 75 (56-141) mJ. All achalasia subtypes showed low EGJW compared to controls (p<0.001). GERD and EoE subjects had EGJW 54.1 (6.9-96 .3) and 65.9 (10.8-102.3) mJ, similar to controls (p<0.08 and p<0.4, respectively). The scleroderma group showed low values of EGJW, 12 mJ (p<0.001). For achalasics, EGJROW was the greatest and had a value of 210.4 (115.2-375.4) mJ. Conclusions: Disease groups with minimal or absent EGJ opening showed low values of EGJW. For achalasics, EGJROW significantly exceeded EGJW values of all other groups highlighting its unique pathophysiology. Balancing the relationship between EGJW and EGJROW is potentially useful for calibrating achalasia treatments and evaluating treatment response.

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Editorial: Widening the Use of the Functional Lumen Imaging Probe to Kids With Eosinophilic Esophagitis: Esophageal Narrowing is not Just an Adult Problem

The American Journal of Gastroenterology ◽

10.1038/ajg.2017.237 ◽

2017 ◽

Vol 112 (9) ◽

pp. 1474-1476 ◽

Cited By ~ 1

Author(s):

Dustin A Carlson

Keyword(s):

Eosinophilic Esophagitis ◽

Imaging Probe ◽

Functional Lumen Imaging Probe

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Evaluation of esophageal distensibility in eosinophilic esophagitis: an update and comparison of functional lumen imaging probe analytic methods

Neurogastroenterology & Motility ◽

10.1111/nmo.12888 ◽

2016 ◽

Vol 28 (12) ◽

pp. 1844-1853 ◽

Cited By ~ 29

Author(s):

D. A. Carlson ◽

Z. Lin ◽

I. Hirano ◽

N. Gonsalves ◽

A. Zalewski ◽

...

Keyword(s):

Eosinophilic Esophagitis ◽

Imaging Probe ◽

Functional Lumen Imaging Probe ◽

Analytic Methods

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Clinical Functional Lumen Imaging Probe Testing in Esophageal Disorders: A Need for Better Quality Evidence

The American Journal of Gastroenterology ◽

10.14309/ajg.0000000000000974 ◽

2020 ◽

Vol 115 (11) ◽

pp. 1799-1801

Author(s):

Benson T. Massey

Keyword(s):

Imaging Probe ◽

Functional Lumen Imaging Probe ◽

Quality Evidence

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Clinical utility of a functional lumen imaging probe in management of dysphagia following head and neck cancer therapies

Endoscopy ◽

10.1055/s-0043-110670 ◽

2017 ◽

Vol 49 (09) ◽

pp. 848-854 ◽

Cited By ~ 9

Author(s):

Peter Wu ◽

Michal Szczesniak ◽

Julia Maclean ◽

Lennart Choo ◽

Harry Quon ◽

...

Keyword(s):

Head And Neck Cancer ◽

Diagnostic Accuracy ◽

Head And Neck ◽

Neck Cancer ◽

Characteristic Curve ◽

Diagnostic Tools ◽

Cross Sectional ◽

Imaging Probe ◽

Functional Lumen Imaging Probe ◽

Dysphagic Patients

Abstract Background and aims Chemoradiotherapy for head and neck cancer (HNC) with/without laryngectomy commonly causes dysphagia. Pharyngoesophageal junction (PEJ) stricturing is an important contributor. We aimed to validate a functional lumen imaging probe (the EndoFLIP system) as a tool for quantitating pretreatment PEJ distensibility and treatment-related changes in HNC survivors with dysphagia and to evaluate the diagnostic accuracy of EndoFLIP-derived distensibility in detecting PEJ strictures. Methods We studied 34 consecutive HNC survivors with long-term (> 12 months) dysphagia who underwent endoscopic dilation for suspected strictures. Twenty non-dysphagic patients undergoing routine endoscopy served as controls. PEJ distensibility was measured at endoscopy with the EndoFLIP system pre- and post-dilation. PEJ stricture was defined as the presence of a mucosal tear post-dilation. Results PEJ stricture was confirmed in 22/34 HNC patients (65 %). During distension up to 60 mmHg, the mean EndoFLIP-derived narrowest cross-sectional area (nCSA) in HNC patients with strictures, without strictures, and in controls were 58 mm2 (95 % confidence interval [CI] 22 to 118), 195 mm2 (95 %CI 129 to 334), and 227 mm2 (95 %CI 168 to 316), respectively. A cutoff of 114 mm2 for the nCSA at the PEJ had perfect diagnostic accuracy in detecting strictures (area under the receiver operating characteristic curve = 1). In patients with strictures, a single session of dilation increased the nCSA by 29 mm2 (95 %CI 20 to 37; P < 0.001). In patients with no strictures, dilation caused no change in the nCSA (mean difference 13 mm2 [95 %CI −4 to 30]; P = 0.13). Conclusions EndoFLIP is a highly accurate technique for the detection of PEJ strictures. EndoFLIP may complement conventional diagnostic tools in the detection of pharyngeal outflow obstruction.

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