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FLIP PLANIMETRY HAS BETTER CORRELATION WITH PREOPERATIVE DYSPHAGIA THAN HIGH-RESOLUTION MANOMETRY IN ANTI-REFLUX SURGERY EVALUATION
Derrius Anderson
*, Jean-Christophe Rwigema, Sullivan A. Ayuso, Kristine Kuchta, Jonathan Chao, Natalie Liu, Mason Hedberg, Michael Ujiki
NorthShore University HealthSystem, Evanston, IL
Functional Lumen Impendence Planimetry (FLIP) has emerged as a facile alternative modality to high resolution manometry (HRM) for evaluating esophageal disorders prior to anti-reflux intervention. HRM evaluates primary peristalsis associated with the swallowing mechanism. FLIP measures secondary peristalsis which measures the intrinsic ability of the esophagus to clear a bolus. Within the anti-reflux surgery community there remains questions of the reliability of FLIP in the preoperative assessment of patients with Gastroesophageal Reflux Disease, especially in circumstances when FLIP findings are discordant from HRM. We hypothesize that patients with preoperative symptoms of dysphagia are more likely to have esophageal dysmotility identified on FLIP rather than HRM.
We retrospectively reviewed a prospectively maintained FLIP database for patients undergoing anti-reflux surgery between 2021 and 2023. A 16cm FLIP probe assessed panometry and planimetry under general anesthesia prior to undergoing anti-reflux surgery. A single panometry reader blinded to preoperative HRM results classified esophageal contractile responses as normal, diminished, or absent. FLIP results were then compared to preoperative HRM results. The discordant FLIP and HRM findings were then analyzed against preoperative subjective dysphagia symptoms and esophagram. Groups were compared using chi-square and t-tests to identify statistically significant differences. Accuracy, sensitivity, specificity, positive and negative predictive value were calculated for FLIP and HRM results.
We included 120 patients who underwent anti-reflux surgery between 2021 and 2023. Discordant FLIP and HRM findings were observed in 29 patients. 26 patients had diminished contractility identified via FLIP with normal HRM findings. Three patients had ineffective esophageal motility diagnosed via HRM with normal FLIP findings. Of the 29 patients included for analysis, 72.4% were women with a mean age of 64 +/- 14. There was no difference in type of hiatal hernia or hernia size. Preoperative dysphagia was reported by 14/29 patients. For patients with preoperative dysphagia FLIP identified dysmotility in all 14 patients, a sensitivity of 100%. Conversely, HRM was normal in all 14 patients who reported preoperative dysphagia, a sensitivity of 0%. Twenty patients within this series had a preoperative esophagram. Abnormal FLIP was seen in 91.67% of patients with evidence of dysmotility on esophagram. Abnormal HRM was seen in 8.33% of patients with dysmotility seen on esophagram.
Abnormal motility observed via FLIP correlates well with subjective dysphagia and dysmotility seen on esophagram. Dysmotility observed via secondary peristalsis may explain the presence of subjective dysphagia during preoperative anti-reflux surgery evaluation in the absence of HRM abnormality.
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