Amanda Bianca1, Valeria Schindler1,2, Larissa Schnurre1, Fritz Murray1, Daniel Runggaldier3, Chandra Prakash Gyawali4, Daniel Pohl1. 1. Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland. 2. Division of Internal Medicine, Stadtspital Triemli, Zurich, Switzerland. 3. Department of Otorhinolaryngology, University Hospital of Zurich, Zurich, Switzerland. 4. Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA.
Abstract
BACKGROUND: The functional lumen imaging probe (FLIP) system is an FDA-approved tool for dynamic evaluation of the esophagogastric junction (EGJ). Even though commercially available since 2009, FLIP utilization remains low, partly due to lack of consensus in methodology and interpretation. Therefore, we aimed to analyze the influence of concurrent endoscopy on FLIP measurements. METHODS: In this single-center study, we reviewed data from 93 patients undergoing FLIP for symptomatic esophageal motility disorders between 2016 and 2018. During sedated endoscopy, we measured luminal values (distensibility, cross-sectional area (CSA), and balloon pressure) at the EGJ and distal esophagus using 30, 40, and 50 mL distension volumes, with and without concurrent endoscope presence. All recorded values were compared at the various distension volumes between the two measurements using a Wilcoxon rank sum test. KEY RESULTS: There was a significant difference in distensibility and CSA with index distension volume (40 mL) at the EGJ comparing the two measurements: Lower median distensibility was 2.1 mm2 mm Hg-1 in the group with concurrent inserted endoscope, respectively, 3.4 mm2 mm Hg-1 without endoscope (P < .001), and median CSA was 86.0 resp. 110.0 mm2 (P < .001). No significant difference could be found in the measurements of the distal esophagus. CONCLUSIONS & INFERENCES: Our results show a significant difference in FLIP measurements with and without endoscope presence. This underlines the importance of establishing a consensus of a standardized FLIP protocol to define normal luminal values and guiding future FLIP diagnostic studies.
BACKGROUND: The functional lumen imaging probe (FLIP) system is an FDA-approved tool for dynamic evaluation of the esophagogastric junction (EGJ). Even though commercially available since 2009, FLIP utilization remains low, partly due to lack of consensus in methodology and interpretation. Therefore, we aimed to analyze the influence of concurrent endoscopy on FLIP measurements. METHODS: In this single-center study, we reviewed data from 93 patients undergoing FLIP for symptomatic esophageal motility disorders between 2016 and 2018. During sedated endoscopy, we measured luminal values (distensibility, cross-sectional area (CSA), and balloon pressure) at the EGJ and distal esophagus using 30, 40, and 50 mL distension volumes, with and without concurrent endoscope presence. All recorded values were compared at the various distension volumes between the two measurements using a Wilcoxon rank sum test. KEY RESULTS: There was a significant difference in distensibility and CSA with index distension volume (40 mL) at the EGJ comparing the two measurements: Lower median distensibility was 2.1 mm2 mm Hg-1 in the group with concurrent inserted endoscope, respectively, 3.4 mm2 mm Hg-1 without endoscope (P < .001), and median CSA was 86.0 resp. 110.0 mm2 (P < .001). No significant difference could be found in the measurements of the distal esophagus. CONCLUSIONS & INFERENCES: Our results show a significant difference in FLIP measurements with and without endoscope presence. This underlines the importance of establishing a consensus of a standardized FLIP protocol to define normal luminal values and guiding future FLIP diagnostic studies.
Authors: Edoardo Savarino; Massimiliano di Pietro; Albert J Bredenoord; Dustin A Carlson; John O Clarke; Abraham Khan; Marcelo F Vela; Rena Yadlapati; Daniel Pohl; John E Pandolfino; Sabine Roman; C Prakash Gyawali Journal: Am J Gastroenterol Date: 2020-11 Impact factor: 12.045
Authors: Rahul Pannala; Kumar Krishnan; Rabindra R Watson; Marcelo F Vela; Barham K Abu Dayyeh; Amit Bhatt; Manoop S Bhutani; Juan Carlos Bucobo; Vinay Chandrasekhara; Andrew P Copland; Pichamol Jirapinyo; Nikhil A Kumta; Ryan J Law; John T Maple; Joshua Melson; Mansour A Parsi; Erik F Rahimi; Monica Saumoy; Amrita Sethi; Guru Trikudanathan; Arvind J Trindade; Julie Yang; David R Lichtenstein Journal: VideoGIE Date: 2021-10-22