A combined endoscopy and functional lumen imaging probe panometry approach can expedite diagnosis of esophageal motility disorders

Abstract

Background and aims: Upper endoscopy and functional lumen imaging probe (FLIP) panometry offer a complementary approach to diagnose esophageal motility disorders during the sedated endoscopy encounter. This study aimed to evaluate an approach combining an endoscopic motility score (CARS) and FLIP panometry to diagnosis esophageal motility disorders.

Methods: Adult patients who completed upper endoscopy with FLIP and high-resolution manometry (HRM) were included. Endoscopic videos were reviewed to determine the CARS score. Esophagogastric junction (EGJ) opening and contractility profile were applied to derive a FLIP panometry motility classification. HRM and Chicago Classification version 4.0 (CCv4.0) were used as the reference standard.

Results: A total of 224 patients (mean age, 52 ± 18 years; 51% female) were included; 112 (50%) had achalasia or conclusive EGJ outflow obstruction (EGJOO) according to HRM and CCv4.0. None of 63 patients with CARS score 0 to 1 and normal EGJ opening on FLIP panometry had achalasia/conclusive EGJOO (100% negative predictive value); 65 of 65 patients with CARS score ≥4 and FLIP panometry classifications of nonspastic obstruction (n = 65) had achalasia or conclusive EGJOO, which was nonspastic in 63 (97% positive predictive value). Of the 96 of 224 (43%) patients with other CARS/FLIP combinations, 47 (49%) had achalasia or conclusive EGJOO.

Conclusions: An approach using endoscopy (CARS score) and FLIP panometry (endoscopy with FLIP panometry [mechanics, anatomy, physiology]) identified actionable esophageal motility disorders at the point-of-care endoscopy encounter. While additional validation is planned, this approach offers a well tolerated method that addresses limitations of HRM. Applied to the index endoscopic encounter, this approach could expedite management, reducing need for HRM in some patients versus triaging toward additional testing in others.