A Standardized Approach to Performing and Interpreting Functional Lumen Imaging Probe Panometry for Esophageal...

Functional lumen imaging probe (FLIP) panometry provides assessment of the esophagogastric junction opening and esophageal body contractile activity during an endoscopic procedure and is increasingly being incorporated into comprehensive esophageal motility assessments. The aim of this study was to provide a standardized approach and vocabulary to the procedure and interpretation and update the motility classification scheme.

A working group of 19 FLIP panometry experts convened in a modified Delphi consensus process to produce and assess statements on the FLIP panometry procedure and interpretation. Three rounds of voting were conducted on an agreement scale of 1-9 for appropriateness, followed by face-to-face discussions and an opportunity for revisions of statements. The "percent agreement" was the proportion of votes with score ≥7 indicating level of agreement on appropriateness.

A total of 40 statements were selected for final inclusion in the Dallas Consensus, including FLIP panometry protocol, interpretation of esophagogastric junction opening and contractile response, and motility classification scheme. Key statements included: "FLIP panometry should be interpreted in the context of the clinical presentation, the accompanying EGD [esophagogastroduodenoscopy] findings and other relevant complementary testing" (median response 9.0; 100% agreement). "A major motor disorder is unlikely in the setting of a 'normal' FLIP panometry classification" (median response 9.0; 94% agreement). "Diminished or absent contractile response with reduced esophageal opening (ie, nonspastic obstruction) supports the diagnosis of a disorder of EGJ [esophagogastric junction] outflow" (median response 8.5; 94% agreement).

The standardized approach for performance and interpretation of the Dallas Consensus can facilitate use of FLIP panometry in broad clinical settings.