499 SUSTAINED ESOPHAGEAL CONTRACTIONS (SEC) BY FLIP PROVIDES ADDITIONAL CHARACTERISTICS ON ESOPHAGEAL DYSMOTILITY IN PATIENTS WITH ESOPHAGEAL SYMPTOMS

Sustained esophageal contractions (SEC) have previously been described on high frequency esophageal ultrasound, high resolution manometry (HRM), and more recently on real time impedance planimetry with functional lumen imaging probe (FLIP). SEC may demonstrate a discoordination between circular and longitudinal esophageal smooth muscle contractions. The aim of this study was to determine the clinical characterization of SEC as detected on FLIP compared to HRM. Methods We performed a retrospective chart review of patients who underwent both FLIP and HRM at our Center for Esophageal Diseases between May 2017 and November 2019. FLIP endoscopic reports were reviewed for the presence of SECs which were defined as vigorous lumen closure ≥5 seconds at the LES or esophageal body as noted by the endoscopist during the real time FLIP examination of a sedated endoscopy. Primary variables recorded included EGJ distensibility index (EGJ-DI), diameter, and the presence of SECs at the 40 mL and 60 mL fill volumes. HRM diagnosis, clinical symptoms and outcomes were also reviewed. Results Of 165 patients who underwent HRM and FLIP imaging, 64 patients (mean age 53.7 years, 20 male) with SECs were included in the study. Among these patients, HRM demonstrated a wide variety of motility disorders (Figure 1). 40% of those with EGJOO, Type II or Type III achalasia, and all patients with jackhammer esophagus had SECs on FLIP imaging. Of 56 patients with normal motility or IEM, 22 had SECs, and 18 patients underwent an endoscopic intervention. Among those who had an intervention, 11 (61%) reported improvement in symptoms with improvement in Eckardt score from 4.9 to 3.9. Conclusion SECs are frequently present in hypercontractile esophageal disorders. Interestingly, 39% of patients with normal motility or IEM have SECs noted on FLIP, and 82% of these patients had an intervention performed based on FLIP findings with 61% reporting symptom improvement. Overall, 19% of patients with normal motility or IEM improved due to interventions performed based on SECs found on FLIP. Detection of SEC during FLIP imaging can guide treatment aimed at relaxation of esophageal muscles.

PS01.006: ROLE OF HIGH RESOLUSION MANOMETRY FOR DIAGNOSIS OF ESOPHAGEAL SPASTIC DISORDERS

Background Esophageal spastic disorders such as spastic (Type III) achalasia, distal esophageal spasm, and Jackhammer esophagus are rare clinical condition. Moreover, symptoms associated with esophageal spastic disorders such as dysphagia, chest pain, regurgitation, and heartburn is not specific to esophageal spastic disorders (Gastroenterol Clin North Am. 42:27–43, 2013.). Therefore, it is difficult to diagnose esophageal spastic disorders from symptoms. The aim of this study is to clarify diagnostic strategy for esophageal spastic disorders. Methods Patients who underwent all of esophagogastroduodenoscopy (EGD), High resolution manometry (HRM: Starlet®)) and esophagography in our Hospital for evaluation of symptoms such as dysphagia, chest pain, regurgitation, and heartburn from November 2013 to November 2017 were involved in the study. After approval by the research ethical committee (No.20150081), we retrospectively reviewed the clinical findings of these patients. Based on the Chicago classification (CC) v3.0 (Neurogastroenterol Motil. 27:160–174, 2015), findings obtained by HRM were classified. Patients who had past history of upper-gastrointestinal surgery were excluded from analysis. Results 174 patients (Mean age of 58.6 ± 15.4; 70male) were finally analyzed. Based on findings obtained by HRM, patients were classified as 25 achalasia, 15 Jackhammer esophagus, 0 distal esophageal spasm, 25 Esophagogastric junction outflow obstruction, 25 weak peristalsis, 6 failed peristalsis, 78 normal. Moreover, 23 patients with achalasia were classified as 8 Type I, 13 Type II, 4 Type III. In each subtype of achalasia, prevalence of esophageal dilation in EGD was 100%, 85%, 0%, respectively. In each subtype of achalasia, prevalence of liquid pool in esophagus in EGD was 100%, 69%, 0%, respectively. In esophagography, Compared with no findings group (15.5 ± 4.3cm), diameter of esophagus in patients with Type III achalasia(12.3 ± 4.8cm) were comparable, however that in patients with Type I(38.9 ± 18.6cm, P < 0.05) or Type II(32.0 ± 10.4cm, P < 0.01) achalasia were significantly wider. In patients with Jackhammer esophagus, prevalence of ring contractions in EGD and prevalence of corkscrew esophagus in esophagography were 33% and 13%, respectively. Conclusion With only EGD and esophagography, it was difficult to find visible findings which suggest esophageal spastic disorders. This suggests efficacy of HRM for diagnosis of this disorder and possibility of hidden esophageal spastic disorders in patients presumed as refractory GERD. Disclosure All authors have declared no conflicts of interest.