Utilizing functional lumen imaging probe in directing treatment for post-fundoplication dysphagia

Samo, Salih; Mulki, Ramzi; Godiers, Marie; Obineme, Chuma; Calderon, Lucie F.; Bloch, J; Kim, Joyce J.; Shahnavaz, Nikrad; Raja, Shreya; Patnana, Srikrishna; Willingham, Field F.; Keilin, Steven; Cai, Qiang; Christie, Jennifer; Srinivasan, Shanthi; Lee, Edward; Davis, S. Scott; Jain, Anrudh K.

doi:10.1007/s00464-020-07941-6

Cited by 10 publications

(6 citation statements)

References 20 publications

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“…While these results appear to differ from previous descriptions of EGJ distensibility in post‐fundoplication dysphagia, our study differs by including a wide range of fundoplication conditions, including disrupted and herniated fundoplications. However, similar to previous studies, “tight” fundoplications identified on endoscopy were found to have significantly lower EGJ‐DI in comparison to herniated fundoplications, supporting the growing role of EGJ‐DI‐directed care in the setting of fundoplication surgery and post‐operative dilation 31,38 . Furthermore, patients evaluated primarily for dysphagia demonstrated decreased maximum EGJ diameter in comparison to those with heartburn/reflux, emphasizing the clinical relevance of the EGJ maximum diameter in symptoms post‐fundoplication; Table S1.…”

Section: Discussionsupporting

confidence: 81%

“…However, similar to previous studies, "tight" fundoplications identified on endoscopy were found to have significantly lower EGJ-DI in comparison to herniated fundoplications, supporting the growing role of EGJ-DI-directed care in the setting of fundoplication surgery and post-operative dilation. 31,38 Furthermore, patients evaluated primarily for dysphagia demonstrated decreased maximum EGJ diameter in comparison to those with heartburn/reflux, emphasizing the clinical relevance of the EGJ maximum diameter in symptoms post-fundoplication;…”

Section: Partial Fundoplicationmentioning

confidence: 99%

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Secondary peristalsis and esophagogastric junction distensibility in symptomatic post‐fundoplication patients

Lu,

Kahrilas,

Teitelbaum

et al. 2024

Neurogastroenterology Motil

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BackgroundThe impact of esophageal dysmotility among patients with post‐fundoplication esophageal symptoms is not fully understood. This study aimed to investigate secondary peristalsis and esophagogastric junction (EGJ) opening biomechanics using functional lumen imaging probe (FLIP) panometry in symptomatic post‐fundoplication patients.MethodsEighty‐seven adult patients post‐fundoplication who completed FLIP for symptomatic esophageal evaluation were included. Secondary peristaltic contractile response (CR) patterns and EGJ opening metrics (EGJ distensibility index (EGJ‐DI) and maximum EGJ diameter) were evaluated on FLIP panometry and analyzed against high‐resolution manometry (HRM), patient‐reported outcomes, and fundoplication condition seen on esophagram and/or endoscopy.Key ResultsFLIP CR patterns included 14 (16%) normal CR, 30 (34%) borderline CR, 28 (32%) impaired/disordered CR, 13 (15%) absent CR, and 2 (2%) spastic reactive CR. Compared with normal and borderline CRs (i.e., CR patterns with distinct, antegrade peristalsis), patients with impaired/disordered and absent CRs demonstrated significantly greater time since fundoplication (2.4 (0.6–6.8) vs. 8.9 (2.6–14.5) years; p = 0.002), greater esophageal body width on esophagram (n = 50; 2.3 (2.0–2.8) vs. 2.9 (2.4–3.6) cm; p = 0.013), and lower EGJ‐DI (4.3 (2.7–5.4) vs. 2.6 (1.7–3.7) mm2/mmHg; p = 0.001). Intact fundoplications had significantly higher rates of normal CRs compared to anatomically abnormal (i.e., tight, disrupted, slipped, herniated) fundoplications (9 (28%) vs. 5 (9%); p = 0.032), but there were no differences in EGJ‐DI or EGJ maximum diameter.Conclusions & InferencesSymptomatic post‐fundoplication patients were characterized by frequent abnormal secondary peristalsis after fundoplication, potentially worsening with time after fundoplication or related to EGJ outflow resistance.

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Section: Discussionsupporting

confidence: 81%

Section: Partial Fundoplicationmentioning

confidence: 99%

Secondary peristalsis and esophagogastric junction distensibility in symptomatic post‐fundoplication patients

Lu,

Kahrilas,

Teitelbaum

et al. 2024

Neurogastroenterology Motil

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“…In post‐Fundoplication dysphagia, FLIP has been proven useful in assessing EGJ obstruction in patients with esophageal symptoms post‐fundoplication (31). In our experience FLIP identified EGJ obstruction with a low DI (<2.8 mm 2 /mmHg).…”

Section: Discussionmentioning

confidence: 99%

Functional Luminal Imaging Probe in the Management of Pediatric Esophageal Disorders

Courbette¹,

Deslandres²,

Drouin³

et al. 2021

J. pediatr. gastroenterol. nutr.

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Background: Functional luminal imaging probe (FLIP) measures pressuregeometry relationships of digestive luminal space. When used in esophageal disorders, it provides several luminal parameters that help better understand the pathophysiology. Data about the potential utility of FLIP in pediatrics are scarce and there is no standardized use in children. We aim to describe the use of FLIP in our center, its safety, feasibility, and clinical impact in esophageal disorders in children. Methods: Consecutive FLIP recordings performed at the Centre Hospitalier Universitaire-Sainte-Justine, Montre ´al, Canada between February 2018 and January 2021 were extracted. A chart review was conducted for demographics and medical history. Symptomatology after the procedure was evaluated with validated dysphagia scores. Key Results: Nineteen patients were included (11 girls, median age 16 years, range 3.2-19.6) with achalasia (n ¼ 5), post-Heller's myotomy dysphagia (n ¼ 3), esophagogastric junction outflow obstruction (n ¼ 3), congenital esophageal stenosis (n ¼ 2); post-esophageal atresia repair stricture (n ¼ 3), and post-fundoplication dysphagia (n ¼ 3). There was no significant correlation between integrated relaxation pressure measured with high resolution manometry and distensibility index (DI). The use of FLIP made it possible to differentiate between dysphagia related to an esophageal obstruction (DI < 2.8 mm 2 /mmHg) and dysphagia without major motility disorder (DI > 2.8 mm 2 /mmHg) that guided the indication for dilation. FLIP led to a change in management in 47% of the patients. Forty-seven percent of the patients were symptom free at the time of the evaluation. Conclusions & Inferences: FLIP provides key esophageal luminal values and therefore can play an important role in pediatric esophageal disorders management.

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“…Alternatively, FLIP may be utilized as a complementary test to corroborate findings from HRM and/or barium esophagram 4 . Other applications of FLIP include objective evaluation of esophageal luminal diameter in the management of esophageal strictures or eosinophilic esophagitis, and monitoring during or following foregut interventions such as myotomy or fundoplication 5–9 …”

Section: Introductionmentioning

confidence: 99%

“…4 Other applications of FLIP include objective evaluation of esophageal luminal diameter in the management of esophageal strictures or eosinophilic esophagitis, and monitoring during or following foregut interventions such as myotomy or fundoplication. [5][6][7][8][9] The current version of FLIP displays impedance planimetry data on screen during the procedure, permitting real-time interpretation in addition to traditional post-procedure interpretation of archived data. 3 Real-time interpretation provides the potential for efficient diagnosis and management of the patient during index endoscopy.…”

Section: Introductionmentioning

confidence: 99%

Inter‐ and intra‐rater agreement of interpretation of functional lumen imaging probe in healthy subjects

Yadlapati

Gyawali

Carlson

et al. 2022

Neurogastroenterology Motil

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Background:The functional lumen imaging probe (FLIP) evaluates esophagogastric junction (EGJ) opening and esophageal contractility. Both post hoc and real-time analyses are possible, but reproducibility and reliability of analysis remain undefined.This study assesses inter-and intra-rater agreement of normative FLIP measurements among novice and experienced users.Methods: Eight motility experts from different institutions independently evaluated de-identified video recordings from 27 asymptomatic healthy subjects using FLIP.Interpretation methods simulating a post-procedure and a live procedure setting were tested. Novice FLIP users (n = 3) received training prior to post-procedure interpretation. Experienced FLIP users (n = 5) interpreted using both methods. Users recorded maximum EGJ and distal esophageal body diameter, distensive pressure, and EGJ distensibility index (EGJ-DI), at balloon fill volumes of 50-, 60-, and 70 ml, as well as repetitive antegrade contractions (RACs). Inter-and intra-rater agreements of diameters, distensive pressure and EGJ-DI were assessed by intra-class correlation coefficient (ICC) and Pearson's correlation coefficient (PCC). Percentage agreement evaluated inter-and intra-rater reliability for RACs.Key Results: Novice and experienced users acquired normative FLIP metrics. Goodto-excellent inter-and intra-rater reliability were achieved for all variables at 60 ml balloon fill volumes. Median parameters at 60 ml balloon fill volume were as follows:EGJ-DI 5.5 mm 2 /mmHg, maximum EGJ diameter 18.6 mm, distensive pressure at maximum EGJ diameter 48.1 mmHg, and distal esophageal body diameter 19.5 mm. Conclusions and Inferences:Normative FLIP parameters can be reliably extracted from FLIP videos using both real-time and post hoc analyses, with high reliability between experienced and novice users.

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Utilizing functional lumen imaging probe in directing treatment for post-fundoplication dysphagia

Cited by 10 publications

References 20 publications

Secondary peristalsis and esophagogastric junction distensibility in symptomatic post‐fundoplication patients

Secondary peristalsis and esophagogastric junction distensibility in symptomatic post‐fundoplication patients

Functional Luminal Imaging Probe in the Management of Pediatric Esophageal Disorders

Inter‐ and intra‐rater agreement of interpretation of functional lumen imaging probe in healthy subjects

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