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EndoFLIP assessment of pyloric sphincter in children: a single-center experience

Mara Popescu1, Emily White2, Mohamed Mutalib1,2

  • 1Faculty of Life Sciences and Medicine, Kings College London, London, UK.

Translational Gastroenterology and Hepatology
|May 17, 2023
PubMed

Insights

Children with neurodisabilities and foregut symptoms often have poor pyloric distensibility. Intrapyloric Botulinum Toxin improved symptoms and pyloric measurements in this study.

Area of Science:

  • Pediatric Gastroenterology
  • Neurodisability Research
  • Medical Device Technology

Background:

  • Gastrointestinal issues like vomiting and poor feeding are prevalent in children with neurodisabilities.
  • The Endolumenal functional lumen imaging probe (EndoFLIP) assesses pyloric compliance and distensibility, predicting treatment response in adults with gastroparesis.
  • This study focuses on pyloric measurements using EndoFLIP in pediatric patients with neuromuscular disabilities and foregut symptoms.

Purpose of the Study:

  • To review pyloric muscle measurements obtained via EndoFLIP in children with neuromuscular disabilities.
  • To evaluate the clinical effectiveness of intrapyloric Botulinum Toxin in this patient group.
  • To correlate EndoFLIP measurements with clinical outcomes.

Main Methods:

  • A retrospective review of clinical notes from March 2019 to January 2022 at Evelina London Children's Hospital.
  • EndoFLIP catheter insertion via an existing gastrostomy tract during endoscopy.
  • Pyloric measurements (diameter, compliance, distensibility) were taken pre- and post-Botulinum Toxin injection at various balloon volumes.

Main Results:

  • 335 measurements from 12 children (mean age 10.7 years) were analyzed.
  • Significant improvements in diameter, compliance, and distensibility were observed post-Botulinum Toxin injection.
  • Eleven out of twelve children reported clinical symptom improvement.

Conclusions:

  • Children with neurodisabilities and foregut symptoms exhibit reduced pyloric distensibility and compliance.
  • EndoFLIP assessment via a gastrostomy tract is a feasible and rapid procedure.
  • Intrapyloric Botulinum Toxin demonstrated safety and efficacy, improving both clinical symptoms and objective measurements in this pediatric cohort.
Abstract

Keywords:
Botulinum toxinchildrenendolumenal functional lumen imaging probe (EndoFLIP)gastrostomypyloric sphincterpylorus

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