Functional Lumen Imaging Probe Measurement Post-Pneumatic Dilation in Clinically Relevant Esophagogastric Junction Outlet Obstruction.

Abstract

Background: Pneumatic dilation (PD) is an effective treatment for disorders of reduced esophageal opening. Functional lumen impedance planimetry (FLIP) can effectively measure lower esophageal sphincter (LES) physiology compared to esophageal standards. The aim of this retrospective cohort analysis was to evaluate if FLIP measurements and esophageal opening classifications changed consistently with symptom improvement post-PD. Also, the aim was to determine if post-PD FLIP measurement correlated with the need for repeat dilation.

Methods: Patients with clinically significant esophagogastric junction outlet obstruction (EGJOO) with reduced esophageal opening (REO) or borderline REO (BrEO) based on FLIP, timed barium esophagram (TBE), and manometry who underwent PD were included. Post-PD FLIP measurements were taken immediately after PD during the same endoscopy encounter.

Results: After PD, average distensibility index (DI) increased from 1.5 mm²/mmHg to 4.7 mm²/mmHg (p < 0.001) and diameter changed from 8.9 mm to 15.9 mm (p < 0.001). Average post-dilation Eckardt score was 1.2, decreasing from an average pre-dilation score of 6.25. Of those requiring repeat dilations, average post-dilation DI was 4.5 mm²/mmHg and diameter 16.4 mm, not statistically different from those that did not undergo repeat procedure (p = 0.79, 0.67, respectively). Post-dilation esophageal openings were all NEO or BnEO. Average Eckardt score at 6-8 week follow-up was not significantly different from those who did not require repeat dilation (1.4, p = 0.112).

Conclusions: PD appears to be associated with improved esophageal opening and a significant change in both DI and diameter, consistent with an improved Eckardt score. Post-dilation DI, diameter, esophageal opening pattern, and Eckardt score did not reveal a trend indicating the need for repeat dilation.