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Esophageal motility classification can be established at the time of endoscopy: a study evaluating real-time functional luminal imaging probe panometry.

ABSTRACT: BACKGROUND AND AIMS:A novel device that provides real-time depiction of functional luminal image probe (FLIP) panometry (ie, esophagogastric junction [EGJ] distensibility and distension-induced contractility) was evaluated. We aimed to compare real-time FLIP panometry interpretation at the time of sedated endoscopy with high-resolution manometry (HRM) in evaluating esophageal motility. METHODS:Forty consecutive patients (aged 24-81 years; 60% women) referred for endoscopy with a plan for future HRM from 2 centers were prospectively evaluated with real-time FLIP panometry during sedated upper endoscopy. The EGJ distensibility index and contractility profile were applied to derive a FLIP panometry classification at the time of endoscopy and again (post-hoc) using a customized program. HRM was classified according to the Chicago classification. RESULTS:Real-time FLIP panometry motility classification was abnormal in 29 patients (73%), 19 (66%) of whom had a subsequent major motility disorder on HRM. All 9 patients with an HRM diagnosis of achalasia had abnormal real-time FLIP panometry classifications. Eleven patients (33%) had normal motility on real-time FLIP panometry and 8 (73%) had a subsequent HRM without a major motility disorder. There was excellent agreement (? = .939) between real-time and post-hoc FLIP panometry interpretation of abnormal motility. CONCLUSIONS:This prospective, multicentered study demonstrated that real-time FLIP panometry could detect abnormal esophageal motility, including achalasia, at the endoscopic encounter. Additionally, normal motility on FLIP panometry was predictive of a benign HRM. Thus, real-time FLIP panometry incorporated with endoscopy appears to provide a suitable and well-tolerated point-of-care esophageal motility assessment.

SUBMITTER: Carlson DA

PROVIDER: S-EPMC6875629 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Esophageal motility classification can be established at the time of endoscopy: a study evaluating real-time functional luminal imaging probe panometry.

Carlson Dustin A DA Gyawali C Prakash CP Kahrilas Peter J PJ Triggs Joseph R JR Falmagne Sophia S Prescott Jacqueline J Dorian Emily E Kou Wenjun W Lin Zhiyue Z Pandolfino John E JE

Gastrointestinal endoscopy 20190704 6

<h4>Background and aims</h4>A novel device that provides real-time depiction of functional luminal image probe (FLIP) panometry (ie, esophagogastric junction [EGJ] distensibility and distension-induced contractility) was evaluated. We aimed to compare real-time FLIP panometry interpretation at the time of sedated endoscopy with high-resolution manometry (HRM) in evaluating esophageal motility.<h4>Methods</h4>Forty consecutive patients (aged 24-81 years; 60% women) referred for endoscopy with a p ...[more]

PMID: 31279625

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Project description:Background & aimsA 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.MethodsWe 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.ResultsHRM 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.ConclusionsIn 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.

Project description:BACKGROUND & AIMS:Functional luminal imaging probe (FLIP) panometry provides a comprehensive evaluation of esophageal functional at the time of endoscopy, including assessment of esophageal distensibility and distension-induced esophageal contractility. However, the few and inconsistent findings from healthy individuals pose challenges to the application of FLIP to research and clinical practice. We performed FLIP panometry in asymptomatic volunteers. METHODS:We performed a prospective study of 20 asymptomatic volunteers (ages, 23-44; 14 women) who were evaluated with 16-cm FLIP positioned across the esophagogastric junction (EGJ) and distal esophagus (and in 8 subjects also repositioned at the proximal esophagus) during sedated upper endoscopy. FLIP data were analyzed with a customized program that generated FLIP panometry plots and calculated the EGJ-distensibility index (DI) and distensibility plateaus (DP) of distal and proximal esophageal body. Distension-induced esophageal contractility was also assessed. RESULTS:The median EGJ-DI was 5.8 mm2/mm Hg (interquartile range [IQR], 4.9-6.7 mm2/mm Hg); all 20 subjects had an EGJ-DI greater than 2.8 mm2/mm Hg. The median DP values from all subjects tested were 20.2 mm (IQR, 19.8-20.8 mm) at the distal body, 21.1 mm (IQR, 20.3-22.9 mm) at the proximal body, and greater than 18 mm at both locations. Repetitive antegrade contractions (RACs) were observed in all 20 subjects; in 19 of 20 (95%) subjects, the RAC pattern persisted for 10 or more consecutive antegrade contractions. CONCLUSIONS:Normal parameters of FLIP panometry are EGJ-DI greater than 2.8 mm2/mm Hg, DP greater than 18 mm, and antegrade contractions that occur in a repetitive pattern (RACs)-these can be used as normal findings for esophageal distensibility and distension-induced contractility. These values can be used in comparative studies of esophageal diseases, such as achalasia and eosinophilic esophagitis, and will facilitate application of FLIP panometry to clinical practice.

Project description:BackgroundThe Chicago Classification version 4.0 (CCv4.0) of ineffective esophageal motility (IEM) is more stringent than the Chicago Classification version 3.0 (CCv3.0) definition. We aimed to compare the clinical and manometric features of patients meeting CCv4.0 IEM criteria (group 1) versus patients meeting CCv3.0 IEM but not CCv4.0 criteria (group 2).MethodsWe collected retrospective clinical, manometric, endoscopic, and radiographic data on 174 adults diagnosed with IEM from 2011 to 2019. Complete bolus clearance was defined as evidence of exit of the bolus by impedance measurement at all distal recording sites. Barium studies included barium swallow, modified barium swallow, and barium upper gastrointestinal series studies, and collected data from these reports include abnormal motility and delay in the passage of liquid barium or barium tablet. These data along with other clinical and manometric data were analyzed using comparison and correlation tests. All records were reviewed for repeated studies and the stability of the manometric diagnoses.ResultsMost demographic and clinical variables were not different between the groups. A lower mean lower esophageal sphincter pressure was correlated with greater percent of ineffective swallows in group 1 (n = 128) (r = -0.2495, P = 0.0050) and not in group 2. In group 1, increased percent of failed contractions on manometry was associated with increased incomplete bolus clearance (r = 0.3689, P = 0.0001). No such association was observed in group 2. A lower median integrated relaxation pressure was correlated with greater percent of ineffective contractions in group 1 (r = -0.1825, P = 0.0407) and not group 2. Symptom of dysphagia was more prevalent (51.6% versus 69.6%, P = 0.0347) in group 2. Dysphagia was not associated with intrabolus pressure, bolus clearance, barium delay, or weak or failed contractions in either group. In the small number of subjects with repeated studies, a CCv4.0 diagnosis appeared more stable over time.ConclusionsCCv4.0 IEM was associated with worse esophageal function indicated by reduced bolus clearance. Most other features studied did not differ. Symptom presentation cannot predict if patients are likely to have IEM by CCv4.0. Dysphagia was not associated with worse motility, suggesting it may not be primarily dependent on bolus transit.

Dataset Information

Esophageal motility classification can be established at the time of endoscopy: a study evaluating real-time functional luminal imaging probe panometry.

Publications

Esophageal motility classification can be established at the time of endoscopy: a study evaluating real-time functional luminal imaging probe panometry.

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