Subjective Assessment of the Pyloric Sphincter During Endoscopy and Its Correlation with FLIP Panometry

Abstract

Background: Visual or haptic assessments of the pylorus during endoscopy may result in the diagnosis of a pylorospasm. However, subjective assessments may be affected by inter-rater variability, the antro-duodenal motility phase and the distance to scope. We evaluated to what extent the visual impression, the endoscopic resistance to pyloric intubation and gastric contents correlate with objectively determined values using EndoFLIP measurements.

Methods: Patients scheduled for FLIP panometry of the upper gastrointestinal tract due to esophageal or epigastric conditions from January 2021 until November 2022 were considered for the study. Inclusion criteria were an EndoFLIP measurement of the pylorus using a standardized protocol for distensibility assessment and documented subjective assessments during upper endoscopy. Statistical analyses including MANOVA and logistic regression were performed for group comparisons and to evaluate significance.

Results: A total of 184 patients (56% female; mean age 49 ± 17.6 years) were included. The subjective assessment modalities of gastric and pyloric dimensions during endoscopy demonstrated high specificity (> 80%) but low sensitivity (< 50%) in detecting pylorospasm. Group comparisons and post hoc tests revealed no consistent significance between different subjective ratings. Logistic regression analysis showed that objectively determined measurements of pyloric dimensions using FLIP panometry were superior to subjective assessments in identifying pyloric dysfunction.

Conclusion: Subjective assessments of the pylorus during endoscopy are not reliable for diagnosing pyloric dysfunction, such as pylorospasm. This highlights the importance of measurements, not estimates, in the evaluation of pyloric function.

Keywords: EndoFLIP; Gastroparesis; Gastroscopy; Motility; Pyloric dysfunction; Pylorospasm; Upper endoscopy.