Predictors of Abnormal Functional Luminal Impedance Planimetry Findings in Non-mechanical Esophagogastric Junction Outfl
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ORIGINAL ARTICLE
Predictors of Abnormal Functional Luminal Impedance Planimetry Findings in Non‑mechanical Esophagogastric Junction Outflow Obstruction Alexander T. Reddy1 · Rahul A. Shimpi2 · Alice Parish3 · Donna Niedzwiecki3 · David A. Leiman2,4 Received: 28 August 2020 / Accepted: 17 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Esophagogastric junction outflow obstruction (EGJOO) is a common but nonspecific motility pattern identified by esophageal high-resolution manometry (HRM). Functional luminal impedance planimetry (FLIP) provides information regarding lower esophageal sphincter (LES) mechanics, which can identify achalasia spectrum disorders and is useful in evaluating EGJOO. However, the relationship between HRM and FLIP parameters in EGJOO is not clearly defined. Aims To identify predictors of abnormal FLIP findings in patients with non-mechanical EGJOO. Methods This is a retrospective cohort study of patients with non-mechanical EGJOO who underwent FLIP between 10/1/16 and 7/1/19. Demographic data including age and gender, examination indication, concomitant medications, HRM parameters, symptom burden, and FLIP metrics of diameter and distensibility index (DI) were collected. DI was categorized as not low (DI > 2.8), borderline low (DI 1.1–2.8), and definitely low (DI ≤ 1). Kruskal–Wallis and Fisher’s exact tests were used to assess the relationship between HRM and FLIP parameters and to identify predictors of abnormal FLIP. Results Among the 44 patients studied, most were female (n = 33, 75%) and the median age was 63. The median IRP was 18.2, and 10 (23%) patients used chronic narcotics. Lower total heartburn and regurgitation scores, and LES diameter by FLIP are associated with definitely low DI. Conclusions In patients with non-mechanical EGJOO, reflux burden scores and FLIP diameters can aid in predicting DI. These results may provide useful adjunctive data to help in differentiating which patients have meaningful outflow obstruction. Keywords Esophagogastric junction outflow obstruction · EGJOO · Functional luminal impedance planimetry · EndoFLIP
Introduction The widespread use of esophageal high-resolution manometry (HRM) has improved diagnostic sensitivity and specificity for numerous disorders [1, 2]. The Chicago Classification * David A. Leiman [email protected] 1
Department of Medicine, Duke University, 2301 Erwin Road, Durham, NC 27710, USA
2
Division of Gastroenterology, Duke University School of Medicine, 200 Morris Street, Suite 6524, Durham, NC 27705, USA
3
Department of Biostatistics and Bioinformatics, Duke University, 2424 Erwin Road, Suite 802, Durham, NC 27705, USA
4
Duke Clinical Research Institute, 2424 Erwin Road, Suite 802, Durham, NC 27705, USA
(CC) provides a hierarchical approach to HRM diagnosis, with primacy placed on disorders of the lower esophageal sphincter (LES), including achalasia subtypes and esophagogastric junction outflow obstruction (EGJOO) [3]. Although defined by HRM p
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