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

Abstract

<div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="title" id="d164924e207">Background and Aims:</h5> <p id="P2">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 to high-resolution manometry (HRM) in evaluating esophageal motility. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="title" id="d164924e212">Methods:</h5> <p id="P3">40 consecutive patients (ages 24 – 81; 60% female) referred for endoscopy with a plan for future HRM from two centers were prospectively evaluated with real-time FLIP panometry during sedated upper endoscopy. The EGJ-distensibility index (DI) 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. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="title" id="d164924e217">Results:</h5> <p id="P4">Real-time FLIP panometry motility classification was abnormal in 29 (73%) patients, 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. 11 (33%) of patients had normal motility on real-time FLIP panometry and 8 (73%) had a subsequent HRM without a major motility disorder. There was excellent agreement (kappa = 0.939) between real-time and post-hoc FLIP panometry interpretation of abnormal motility. </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="title" id="d164924e222">Conclusions:</h5> <p id="P5">This prospective, multi-centered 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. </p> </div>