Functional Luminal Imaging Probe Assessment in Postfundoplication Patients Changes Management Beyond Manometry

Area of Science:

• Pediatric Gastroenterology
• Surgical Outcomes Research
• Gastrointestinal Physiology

Background:

• Fundoplication is a common pediatric surgery, but postoperative symptoms can be nonspecific and require further investigation.
• Evaluating the causes of these symptoms is crucial for effective patient management.

Purpose of the Study:

• To determine the utility of Functional Luminal Imaging Probe (FLIP) compared to high-resolution manometry with impedance (HRIM) in assessing symptoms after fundoplication.
• To compare FLIP findings in fundoplication patients with those in pediatric achalasia and control groups.

Main Methods:

• Review of FLIP and HRIM tracings from symptomatic fundoplication patients.
• Comparison of FLIP results between fundoplication, achalasia, and control patient cohorts.
• Assessment of FLIP's role versus HRIM in clinical decision-making and outcomes.

Main Results:

• Esophagogastric junction (EGJ) distensibilities in fundoplication patients varied, showing a linear relationship with adjusted balloon fill volume.
• Fundoplication patients had lower EGJ distensibilities than controls but higher than achalasia patients (P=0.0001).
• Patients undergoing EGJ intervention had significantly lower mean EGJ distensibility (2.3 mm/mmHg) compared to medically managed patients (5.1 mm/mmHg) (P=0.0001).

Conclusions:

• FLIP provides additional insights into EGJ physiology in symptomatic fundoplication patients.
• FLIP serves as a valuable complementary tool to HRIM for evaluating these patients.
• Understanding EGJ mechanics is key to managing post-fundoplication symptoms.