Alexandra J Baumann1, Erica N Donnan1, Joseph R Triggs2, Wenjun Kou1, Jacqueline Prescott1, Alex Decorrevont1, Emily Dorian1, Peter J Kahrilas1, John E Pandolfino1, Dustin A Carlson3. 1. Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 2. Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 3. Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Electronic address: dustin-carlson@northwestern.edu.
Abstract
BACKGROUND & AIMS: A normal esophageal response to distension on functional luminal imaging probe (FLIP) panometry during endoscopy might indicate normal esophageal motor function. We aimed to investigate the correlation of normal FLIP panometry findings with esophageal high-resolution manometry (HRM) and outcomes of discrepant patients. METHODS: We performed a retrospective study using data from a registry of patients who completed FLIP during sedated endoscopy. We identified 111 patients with normal FLIP panometry findings (mean age, 42 y; 69% female) and corresponding HRM data. A normal FLIP panometry was defined as an esophagogastric junction (EGJ) distensibility index greater than 3.0 mm2/mm Hg, an absence of repetitive retrograde contractions, and a repetitive antegrade contraction pattern that met the Rule-of-6s: ≥6 consecutive antegrade contractions of ≥6-cm in length, at a rate of 6 ± 3 contractions per minute. HRM findings were classified by the Chicago classification system version 3.0. RESULTS: HRM results were classified as normal motility in 78 patients (70%), ineffective esophageal motility in 10 patients (9%), EGJ outflow obstruction in 20 patients (18%), and 3 patients (3%) as other. In patients with EGJ outflow obstruction based on HRM, the integrated relaxation pressure normalized on adjunctive swallows in 16 of 20 patients (80%), and in 8 of 9 patients (88%) who completed a barium esophagram and had normal barium clearance. Thus, although 23 of 111 patients (21%) with normal FLIP panometry had abnormal HRM findings, these HRMs often were considered to be false-positive or equivocal results. All patients with an abnormal result from HRM were treated conservatively. CONCLUSIONS: In a retrospective cohort study, we found that patients with normal FLIP panometry results did not have a clinical impression of a major esophageal motor disorder. Normal FLIP panometry results can exclude esophageal motility disorders at the time of endoscopy, possibly negating the need for HRM in select patients.
BACKGROUND & AIMS: A normal esophageal response to distension on functional luminal imaging probe (FLIP) panometry during endoscopy might indicate normal esophageal motor function. We aimed to investigate the correlation of normal FLIP panometry findings with esophageal high-resolution manometry (HRM) and outcomes of discrepant patients. METHODS: We performed a retrospective study using data from a registry of patients who completed FLIP during sedated endoscopy. We identified 111 patients with normal FLIP panometry findings (mean age, 42 y; 69% female) and corresponding HRM data. A normal FLIP panometry was defined as an esophagogastric junction (EGJ) distensibility index greater than 3.0 mm2/mm Hg, an absence of repetitive retrograde contractions, and a repetitive antegrade contraction pattern that met the Rule-of-6s: ≥6 consecutive antegrade contractions of ≥6-cm in length, at a rate of 6 ± 3 contractions per minute. HRM findings were classified by the Chicago classification system version 3.0. RESULTS: HRM results were classified as normal motility in 78 patients (70%), ineffective esophageal motility in 10 patients (9%), EGJ outflow obstruction in 20 patients (18%), and 3 patients (3%) as other. In patients with EGJ outflow obstruction based on HRM, the integrated relaxation pressure normalized on adjunctive swallows in 16 of 20 patients (80%), and in 8 of 9 patients (88%) who completed a barium esophagram and had normal barium clearance. Thus, although 23 of 111 patients (21%) with normal FLIP panometry had abnormal HRM findings, these HRMs often were considered to be false-positive or equivocal results. All patients with an abnormal result from HRM were treated conservatively. CONCLUSIONS: In a retrospective cohort study, we found that patients with normal FLIP panometry results did not have a clinical impression of a major esophageal motor disorder. Normal FLIP panometry results can exclude esophageal motility disorders at the time of endoscopy, possibly negating the need for HRM in select patients.
Authors: Dustin A Carlson; C Prakash Gyawali; Peter J Kahrilas; Joseph R Triggs; Sophia Falmagne; Jacqueline Prescott; Emily Dorian; Wenjun Kou; Zhiyue Lin; John E Pandolfino Journal: Gastrointest Endosc Date: 2019-07-04 Impact factor: 9.427
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Authors: Dustin A Carlson; Alexandra J Baumann; Jacqueline E Prescott; Erica N Donnan; Rena Yadlapati; Abraham Khan; C Prakash Gyawali; Wenjun Kou; Peter J Kahrilas; John E Pandolfino Journal: Neurogastroenterol Motil Date: 2021-06-13 Impact factor: 3.598
Authors: Dustin A Carlson; Alexandra J Baumann; Jacqueline E Prescott; Jacob M Schauer; Amanda Krause; Erica N Donnan; Wenjun Kou; Peter J Kahrilas; John E Pandolfino Journal: Am J Gastroenterol Date: 2021-10-01 Impact factor: 12.045
Authors: Dustin A Carlson; Jacqueline E Prescott; Alexandra J Baumann; Jacob M Schauer; Amanda Krause; Erica N Donnan; Wenjun Kou; Peter J Kahrilas; John E Pandolfino Journal: Clin Gastroenterol Hepatol Date: 2021-06-30 Impact factor: 13.576
Authors: Dustin A Carlson; Alexandra J Baumann; Erica N Donnan; Amanda Krause; Wenjun Kou; John E Pandolfino Journal: Neurogastroenterol Motil Date: 2021-03-11 Impact factor: 3.960
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