Utilizing functional lumen imaging probe in directing treatment for post-fundoplication dysphagia

Area of Science:

• Gastroenterology
• Surgical Outcomes
• Diagnostic Imaging

Background:

• Esophagogastric junction obstruction (EGJO) following fundoplication (PF) presents diagnostic challenges.
• Current diagnostic methods for PF-EGJO lack definitive accuracy.

Purpose of the Study:

• To evaluate the diagnostic accuracy of EGJ opening using Functional Lumen Imaging Probe (FLIP).
• To assess the effectiveness of pneumatic dilation in patients with FLIP-detected EGJO and dysphagia.

Main Methods:

• Prospective data collection from PF patients with dysphagia.
• EGJO diagnosis via endoscopy, esophagram, and FLIP's EGJ-distensibility index (DI).
• Stepwise pneumatic dilation to 20, 30, or 35 mm for EGJO patients, with outcome assessment via dysphagia improvement.

Main Results:

• 17 out of 26 patients (65%) exhibited a low EGJ-DI on FLIP.
• High concordance (85%) between FLIP-DI and combined endoscopy/esophagram assessments.
• Significant dysphagia improvement (mean 60%) post-dilation, with 9/11 patients experiencing ≥50% improvement.

Conclusions:

• Functional Lumen Imaging Probe (FLIP) is a reliable tool for diagnosing EGJO post-fundoplication.
• FLIP-based EGJ-DI can guide patient selection for pneumatic dilation, leading to substantial dysphagia relief.