Evaluating esophageal motility beyond primary peristalsis: Assessing esophagogastric junction opening mechanics and secondary peristalsis in patients with normal manometry. Issue 10 (11th March 2021)

• Record Type: Journal Article
• Authors: Carlson, Dustin A.; Baumann, Alexandra J.; Donnan, Erica N.; Krause, Amanda; Kou, Wenjun; Pandolfino, John E.
• Is Part Of: Neurogastroenterology & motility. Volume 33:Issue 10(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-03-11
• Subjects: achalasia -- dysphagia -- impedance -- peristalsis; Gastrointestinal system -- Motility -- Periodicals; Gastrointestinal system -- Innervation -- Periodicals; 616.33
• DOI: 10.1111/nmo.14116
• Languages: English
• ISSNs: 1350-1925

Abstract

Abstract: Background: Functional luminal imaging probe (FLIP) Panometry assesses the esophageal response to distention and may complement the assessment of primary peristalsis on high‐resolution manometry (HRM). We aimed to investigate whether FLIP Panometry provides complementary information in patients with normal esophageal motility on HRM. Methods: Adult patients that completed FLIP and had an HRM classification of normal motility were retrospectively identified for inclusion. 16‐cm FLIP studies performed during endoscopy were evaluated to assess EGJ distensibility, secondary peristalsis, and identify an abnormal response to distention involving sustained LES contraction (sLESC). Clinical characteristics and esophagram were assessed when available. Key Results: Of 164 patients included (mean(SD) age 48(16) years, 75% female), 111 (68%) had normal Panometry with EGJ‐distensibility index (DI) ≥2.0 mm 2 /mmHg, maximum EGJ diameter ≥16mm and antegrade contractions. Abnormal EGJ distensibility was observed in 44/164 (27%), and 38/164 (23%) had an abnormal contractile response to distension. sLESC was observed in 11/164 (7%). Among 68 patients that completed esophagram, abnormal EGJ distensibility was more frequently observed with an abnormal esophagram than normal EGJ opening: 14/23 (61%) vs 10/45 (22%); P=0.003. Epiphrenic diverticula were present in 3/164 patients: 2/3 had sLESC. Conclusions & Inferences: Symptomatic patients with normal esophageal motility on HRM predominantly have normal FLIP Panometry; however, abnormal FLIP findings can be observed. While abnormal Panometry findings appear clinically relevant via an association with abnormal bolus retention, complementary tests, such as provocative maneuvers with HRM and timed barium esophagram, are useful to determine clinical context. Abstract : Most symptomatic patients with normal esophageal motility on manometry had normal FLIP Panometry findings. However abnormal FLIP responses appeared clinically relevant (e.g. associated with esophageal retention), thus should be clinically correlated with complementary tests.