THE ROLE OF A FUNCTIONAL LUMEN IMAGING PROBE AS A PART OF THE COMPREHENSIVE ESOPHAGEAL WORKUP PRIOR TO ANTIREFLUX SURGERY
Bailey Su*1,2, Zachary M. Callahan2, Stephanie M. Novak2, Kristine Kuchta2, Michael Ujiki2
1University of Chicago, Chicago, IL; 2NorthShore University Health System, Evanston, IL
Introduction
The functional lumen imaging probe (FLIP) is an innovative tool that uses impedance planimetry to assess esophageal geometry in real time. Our objective is to determine whether FLIP can aid in the comprehensive esophageal workup prior to antireflux surgery.
Methods
This is a retrospective review of a prospectively maintained quality database at a single center. Seventy-five patients underwent laparoscopic hiatal hernia repair with fundoplication and gastroesophageal junction (GEJ) assessment with FLIP. At the beginning of the operation, FLIP was used to measure minimum diameter (Dmin), intra-balloon pressure, and distensibility index (DI) of the GEJ. Measurements were compared to pre-operative manometry and pH study results using Pearson correlation coefficients, Wilcoxon rank-sum and Fisher's exact tests.
Results
Patients with a DI < 2 mm2/mmHg were significantly more likely to have abnormal peristalsis (32.1% vs 7.5%, p=0.02). Similarly, patients with abnormal impedance had a significantly lower DI than those with normal impedance (median 1.8 vs. 2.4, p=0.041). A DI < 2 was able to detect abnormal peristalsis with a sensitivity of 75.0% and specificity of 66.1%. Lower resting lower esophageal sphincter (LES) pressures were significantly associated with a larger Dmin (r = 0.241, P=0.045), however there was no correlation between resting LES pressures and DI (r=-0.186, P=0.13). When comparing normal resting LES pressures (12 mmHg-60 mmHg) to hypotonic LES pressures (< 12 mmHg), there was no difference in DI (median 2.4 vs. 2.3, p=0.67).
There was no significant correlation between DeMeester score, number of acid reflux episodes, number of acid reflux episodes > 5 minutes, total time or total percent time of esophageal pH < 4 and any of the FLIP measurements.
Conclusion
Patients who had abnormal peristalsis on manometry had significantly lower Dmin and DI than those with normal peristalsis. Its ability to detect abnormal peristalsis with a sensitivity of 75%, means FLIP can potentially serve as an adjunct to surgeons when deciding between a Nissen or partial fundoplication, but may not be sensitive enough to diagnose abnormal esophageal motility prior to antireflux surgery. Additionally, FLIP cannot be used to detect pathologic reflux and cannot supplant pH studies in the diagnosis of GERD.
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