P0434 - Endoscopic Functional Luminal Imaging Probe as a Tool for the Diagnosis of EGJOO: A Single Center Experience

Jose V. Camilion, BA¹, Gala Godoy Brewer, MD², Ernesto Robalino Gonzaga, MD³, Robert S. Bulat, MD⁴, Tsion Abdi, MD⁵, Olaya I. Brewer, MD^6
1Nova Southeastern University, Miami, FL; ²University of Miami/Jackson Memorial Hospital, Miami, FL; ³AdventHealth, Orlando, FL; ⁴Johns Hopkins Hospital, Baltimore, MD; ⁵Johns Hopkins Hospital, Columbia, MD; ⁶Johns Hopkins Hospital, Sibley Memorial Hospital, Washington, DC

Introduction: High Resolution Esophageal Manometry (HREM) is the gold standard for the diagnosis of esophageal motility disorders, including esophagogastric junction outflow obstruction (EGJOO), with an elevated integrated relaxation pressure (IRP). EGJOO is reported in 3-17% of patients undergoing HREM, but in two thirds of these, the IRP is not associated with true outflow obstruction. Endoscopic Functional Luminal Imaging Probe (EndoFLIP) is a tool to assess the lower esophageal sphincter (LES) and it may be a potentially useful alternative in diagnosing EGJOO, with the benefit of being performed during an upper endoscopy. This study analyzes the results of EndoFLIP vs HREM in the detection of EGJOO.

Methods: This was a retrospective study performed at a tertiary care center. Patients 18 years of age or older who underwent HREM and EndoFLIP using the EF-322 catheter were included. The Chicago Classification v4.0 was used to describe the findings. Patients were excluded if they underwent EndoFLIP with the EF-325 catheter, had altered anatomy, did not complete the HREM study, or if HREM and EndoFLIP were longer than a year apart. The area under the curve (AUC) under 0.7 was used to estimate significance of results. Statistical significance was represented by p < 0.05.

Results: A total of 32 patient were included. Median age at the time of procedure was 55.9 years [IQR 45.2-61.4], 75% were females. 53% were white, 34% were black, and 13% were Asian or others. The main indications were GERD symptoms in 34% and dysphagia in 37%. The median DI at 40mL was 1.1mm²/mmHg [n=13] in EGJOO compared to 2.8mm²/mmHg [n=19] in patients with a normal HREM (p=0.002), with the AUC of 0.832. At 50mL, the median DI was 1.5mm²/mmHg [n=12] vs 3.4mm²/mmHg [n=17] in EGJOO vs normal HREM. At 60mL, the median DI was 2.3mm²/mmHg [n=12] compared to 5.3mm²/mmHg [n=16] in EGJOO vs normal HREM (p=0.006, AUC 0.810) (Figure 1) For CSA, The AUC was above 0.7 at 50 and 60mL. For diameter, the AUC was 0.8 (p=0.001), and in regards to pressures, the AUC was higher at 40mL (0.749) than 50mL (0.745)(Table 1)



Discussion: Our data shows that EndoFLIP can be a reliable tool for the diagnosis and screening of EGJOO. More studies are needed to validate this tool, but it could potentially become useful and better tolerable than HREM, improving patient care.




Disclosures:


Jose V. Camilion, BA¹, Gala Godoy Brewer, MD², Ernesto Robalino Gonzaga, MD³, Robert S. Bulat, MD⁴, Tsion Abdi, MD⁵, Olaya I. Brewer, MD⁶. P0434 - Endoscopic Functional Luminal Imaging Probe as a Tool for the Diagnosis of EGJOO: A Single Center Experience, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.