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Distensibility of the esophagogastric junction assessed with the functional lumen imaging probe ( FLIP ™) in achalasia patients
Author(s) -
Pandolfino J. E.,
Ruigh A.,
Nicodème F.,
Xiao Y.,
Boris L.,
Kahrilas P. J.
Publication year - 2013
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/nmo.12097
Subject(s) - achalasia , esophagogastric junction , distension , medicine , high resolution manometry , lumen (anatomy) , gastroenterology , cardiology , esophagus , adenocarcinoma , cancer
Background The functional lumen imaging probe ( FLIP ), measures esophagogastric junction ( EGJ ) distensibility (cross‐sectional area/luminal pressure) during volume‐controlled distension. The aim of this study is to apply this tool to the assessment of the EGJ in untreated and treated achalasia patients and to compare EGJ distensibility with other diagnostic tools utilized in managing achalasia. Methods Findings from FLIP , high‐resolution manometry ( HRM ), timed barium esophagram, and symptom assessment by Eckardt Score ( ES ) were compared in 54 achalasia patients (23 untreated, 31 treated). Twenty healthy volunteers underwent FLIP as a comparator group. The EGJ distensibility index ( EGJ ‐ DI ) was defined at the ‘waist’ of the FLIP bag during volumetric distension, expressed in mm 2 mmHg −1 . The ES was used to gauge treatment outcome: good response < 3 or poor response ≥ 3. Key Results Of the 31 treated patients, 17 had good and 14 poor treatment response. The EGJ ‐ DI was significantly different among groups, greatest in the control subjects and least in the untreated patients; patients with good treatment response had significantly greater EGJ ‐ DI than untreated or patients with poor response. The correlations between EGJ ‐ DI and ES and integrated relaxation pressure on HRM were significant. Conclusions & Inferences The FLIP provided a useful measure of EGJ distensibility in achalasia patients that correlated with symptom severity. The measurement of EGJ distensibility was complementary to existing tests suggesting a potentially important role in the clinical management of achalasia.