The Combined Utility of the CARS Endoscopic Score and Functional Lumen Imaging Probe (FLIP) Based on Real-Time...

During endoscopy, which often is the initial diagnostic test performed for esophageal symptoms, a CARS endoscopic score can be calculated and functional lumen imaging probe (FLIP) panometry can be performed. Recently, the combination of a CARS score > 4 calculated from endoscopic videos and non-spastic obstruction on FLIP noted from offline analysis has been found to be highly predictive of disorders of EGJ outflow obstruction (i.e., achalasia and conclusive EGJOO). We aimed to validate these findings based on detailed assessments performed in real time during endoscopy and FLIP panometry with reclassification based on the CARS score and Dallas Consensus for FLIP panometry.

We reviewed our clinical database to identify patients who had endoscopy with documentation of an esophageal motility examination (i.e., components of the CARS score and FLIP with documented EGJ-diameter/distensibility, contractile response pattern at each volume) and HRM performed at our Center for Esophageal Diseases. CARS scores were calculated from score components documented in the endoscopy report and FLIP panometry classifications were reclassified according to the Dallas Consensus. Manometric diagnosis was based on Chicago Classification v4.0 (CCv4.0).

In 120 patients (mean age 55.5 years, 66% female), the combination of CARS score ≥ 4 and reduced EGJ opening (REO) on FLIP was highly suggestive of an EGJ obstruction diagnosis (achalasia or conclusive EGJOO) with 100% specificity and 100% positive predictive value.

A CARS score ≥ 4 combined with FLIP-REO obtained in real time during endoscopy is highly predictive of an EGJ obstruction diagnosis (achalasia or confirmed EGJOO) on HRM.