Functional Luminal Imaging Probe Panometry Identifies Achalasia-Type Esophagogastric Junction Outflow Obstruction

Triggs, Joseph; Carlson, Dustin A.; Beveridge, Claire; Kou, Wenjun; Kahrilas, Peter J.; Pandolfino, John E.

doi:10.1016/j.cgh.2019.11.037

Cited by 73 publications

(91 citation statements)

References 18 publications

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“… The cutoff of spasm in 20% of swallows is arbitrary, and confidence in a diagnosis of a type III achalasia variant may be increased with a higher number of premature/spastic swallows. Supportive testing with a TBE, preferably in conjunction with a barium tablet swallow, and/or FLIP should be performed in patients with an inconclusive diagnosis of achalasia in the setting of dysphagia as a presenting symptom (Very Low GRADE, Strong Recommendation) 12,13,37–43 Opioids are associated with type III achalasia and patients should be studied off opioid medication if possible (Low GRADE, Conditional Recommendation) 44,45 .…”

Section: Achalasiamentioning

confidence: 99%

Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0^©

Yadlapati

Kahrilas

Fox

et al. 2020

Neurogastroenterology Motil

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607

429

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Chicago Classification v4.0 (CCv4.0) is the updated classification scheme for esophageal motility disorders using metrics from high‐resolution manometry (HRM). Fifty‐two diverse international experts separated into seven working subgroups utilized formal validated methodologies over two‐years to develop CCv4.0. Key updates in CCv.4.0 consist of a more rigorous and expansive HRM protocol that incorporates supine and upright test positions as well as provocative testing, a refined definition of esophagogastric junction (EGJ) outflow obstruction (EGJOO), more stringent diagnostic criteria for ineffective esophageal motility and description of baseline EGJ metrics. Further, the CCv4.0 sought to define motility disorder diagnoses as conclusive and inconclusive based on associated symptoms, and findings on provocative testing as well as supportive testing with barium esophagram with tablet and/or functional lumen imaging probe. These changes attempt to minimize ambiguity in prior iterations of Chicago Classification and provide more standardized and rigorous criteria for patterns of disorders of peristalsis and obstruction at the EGJ.

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Section: Achalasiamentioning

confidence: 99%

Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0^©

Yadlapati

Kahrilas

Fox

et al. 2020

Neurogastroenterology Motil

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607

429

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“…Seven studies (Table 4) included patients with other major motility disorders than achalasia (ie, esophago‐gastric junction outflow obstruction: EGJOO) 13,30,35‐39 . One study 36 showed that patients with EGJOO on HRM and pathological TBE had a lower EGJ DI ( P = .03) than patients with EGJOO on HRM and normal TBE (LE 3) with a cutoff value of 2.0 mm 2 /mm Hg (NPV: 100% and PPV: 75%). These results suggest that EGJ DI could help to identify patients with EGJOO that could undergo achalasia‐like therapy, but there is a need for confirmatory studies.…”

Section: Resultsmentioning

confidence: 99%

The use of impedance planimetry (Endoscopic Functional Lumen Imaging Probe, EndoFLIP^®) in the gastrointestinal tract: A systematic review

Desprez

Roman

Leroi

et al. 2020

Neurogastroenterology Motil

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Background and purpose The EndoFLIP® system is a method of delineating impedance and was first designed to investigate the characteristics of the esophago‐gastric junction. In the last decade, its use was widened to investigate other sphincteric and non‐sphincteric systems of the gastrointestinal tract. The objective of the present systematic review was to summarize the available data in literature on the use of the EndoFLIP® system in the gastrointestinal tract, including sphincteric and non‐sphincteric regions. We performed a systematic review in accordance with recommendations for systematic review using PRISMA guidelines without date restriction, until June 2020, using MEDLINE‐PubMed, Cochrane Library, and Google Scholar databases. Only articles written in English were included in the present review. Five hundred and six unique citations were identified from all database combined. Of those, 95 met the inclusion criteria. There was a lack of standardization among studies in terms of anesthetic drugs use, probe placement, and inflation protocol. In most cases, only small cohorts of patients were included. Most studies investigated the EGJ, with a potential use of the EndoFLIP® to identify a subgroup of patients with achalasia and for intraoperative assessment of treatment efficacy in achalasia. However, the use of EndoFLIP® in the esophageal body (esophageal panometry), other esophageal diseases (gastro‐esophageal reflux disease, eosinophilic esophagitis), and other sphincter regions (anal canal, pylorus) will need further confirmatory studies. The EndoFLIP® system provides detailed geometric data of the gastrointestinal lumen but further works are needed to determine its use in clinical practice.

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“…47 A recent retrospective study showed promising results for FLIP. 48 An EGJ-DI less than 2 mm 2 /mmHg had a positive predictive value of 75% and a negative predictive value of 100% for identifying radiographic evidence of EGJOO, which was defined as liquid barium retention and/or barium tablet impaction. Furthermore, studies showed that FLIP can be useful to help diagnose a subgroup of patients with clinical and radiological features of achalasia but does not meet manometric criteria.…”

Section: Which Investigations Should Be Offered To Patients?mentioning

confidence: 99%

How to approach esophagogastric junction outflow obstruction?

Patcharatrakul

Alkaddour

Pitisuttithum

et al. 2020

Annals of the New York Academy of Sciences

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The diagnosis of esophagogastric junction outflow obstruction (EGJOO) is currently based on high‐resolution esophageal manometry and is characterized by impaired EGJ relaxation with preserved esophageal peristalsis. This condition has been defined by the Chicago Classification as a major esophageal motility disorder, although its clinical significance is controversial since heterogeneous and irrelevant presentations have been reported. EGJOO commonly has a benign clinical course, with spontaneous resolution, but it can also be associated with opioid usage, early achalasia, and mechanical obstruction. A careful medical, surgical, and medication history coupled with a careful manometry interpretation focused on the factors that might affect the integrated relaxation pressure are the keys for an accurate diagnosis. The advance of esophageal physiological tests can evaluate the clearance of the esophageal contents across the EGJ. The manometry technique, including testing in an upright position and provocative tests, can also complement those tests and demonstrate the evidence of EGJ obstruction. After making a diagnosis, endoscopy should be an initial step to exclude anatomical causes if it has not yet been done. Imaging studies can identify infiltrative lesions, but the reported diagnostic yield is relatively low. Management of EGJOO depends on the underlying etiology. Functional EGJOO patients with persistent dysphagia associated with the presence of outflow obstruction may require EGJ disruption therapy.

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Functional Luminal Imaging Probe Panometry Identifies Achalasia-Type Esophagogastric Junction Outflow Obstruction

Cited by 73 publications

References 18 publications

Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0^©

Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0^©

The use of impedance planimetry (Endoscopic Functional Lumen Imaging Probe, EndoFLIP^®) in the gastrointestinal tract: A systematic review

How to approach esophagogastric junction outflow obstruction?

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Functional Luminal Imaging Probe Panometry Identifies Achalasia-Type Esophagogastric Junction Outflow Obstruction

Cited by 73 publications

References 18 publications

Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0©

Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0©

The use of impedance planimetry (Endoscopic Functional Lumen Imaging Probe, EndoFLIP®) in the gastrointestinal tract: A systematic review

How to approach esophagogastric junction outflow obstruction?

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Product

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Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0^©

Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0^©

The use of impedance planimetry (Endoscopic Functional Lumen Imaging Probe, EndoFLIP^®) in the gastrointestinal tract: A systematic review