Utilizing functional lumen imaging probe in directing treatment for post-fundoplication dysphagia
Background Esophagogastric junction obstruction (EGJO) post-fundoplication (PF) is difficult to identify with currently available tests. We aimed to assess the diagnostic accuracy of EGJ opening on functional lumen imaging probe (FLIP) and dilation outcome in FLIP-detected EGJO in PF dysphagia. Meth...
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| Veröffentlicht in: | Surgical endoscopy 2021-08, Vol.35 (8), p.4418-4426 |
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| creator | Samo, Salih Mulki, Ramzi Godiers, Marie L. Obineme, Chuma G. Calderon, Lucie F. Bloch, John M. Kim, Joyce J. Shahnavaz, Nikrad Raja, Shreya M. Patnana, Srikrishna V. Willingham, Field F. Keilin, Steven A. Cai, Qiang Christie, Jennifer A. Srinivasan, Shanthi Lin, Edward Davis, S. Scott Jain, Anand S. |
| description | Background
Esophagogastric junction obstruction (EGJO) post-fundoplication (PF) is difficult to identify with currently available tests. We aimed to assess the diagnostic accuracy of EGJ opening on functional lumen imaging probe (FLIP) and dilation outcome in FLIP-detected EGJO in PF dysphagia.
Methods
We prospectively collected data on PF patients referred to Esophageal Clinic over 18 months. EGJO diagnosis was made by (a) endoscopist’s description of a narrow EGJ/wrap area, (b) appearance of wrap obstruction or contrast/tablet retention on esophagram, or (c) EGJ-distensibility index (DI) |
| doi_str_mv | 10.1007/s00464-020-07941-6 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2439976941</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2549099282</sourcerecordid><originalsourceid>FETCH-LOGICAL-c352t-756fb050314aff006c1c3d2cdbe172c5b73529d6171812b9526fa6a86846aea63</originalsourceid><addsrcrecordid>eNp9kE1LxDAQhoMouK7-AU8BL16ikzRNm6MsfoHgxT2HNE3XLN22Ju1h_fVOXUHw4CmQed6XmYeQSw43HKC4TQBSSQYCGBRacqaOyILLTDAheHlMFqAzYAJHp-QspS0gr3m-IHY9hjZ8hm5Dm6lzY-g729J22vmOhp3dzIMh9pWnoaN1iB4R_BqjtyMyI236SIc-jQzjdT-0wdm5hNb7NLxj3p6Tk8a2yV_8vEuyfrh_Wz2xl9fH59XdC3NZLkZW5KqpIIeMS9s0AMpxl9XC1ZXnhXB5VSCma8ULXnJR6VyoxipbqlIq663KluT60Ivrfkw-jWYXkvNtazvfT8kImWldKJSD6NUfdNtPEQ9HKpcatBalQEocKBf7lKJvzBBRSdwbDma2bg7WDVo339bNvEV2CCWEu42Pv9X_pL4ARA-F0Q</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2549099282</pqid></control><display><type>article</type><title>Utilizing functional lumen imaging probe in directing treatment for post-fundoplication dysphagia</title><source>SpringerLink Journals - AutoHoldings</source><creator>Samo, Salih ; Mulki, Ramzi ; Godiers, Marie L. ; Obineme, Chuma G. ; Calderon, Lucie F. ; Bloch, John M. ; Kim, Joyce J. ; Shahnavaz, Nikrad ; Raja, Shreya M. ; Patnana, Srikrishna V. ; Willingham, Field F. ; Keilin, Steven A. ; Cai, Qiang ; Christie, Jennifer A. ; Srinivasan, Shanthi ; Lin, Edward ; Davis, S. Scott ; Jain, Anand S.</creator><creatorcontrib>Samo, Salih ; Mulki, Ramzi ; Godiers, Marie L. ; Obineme, Chuma G. ; Calderon, Lucie F. ; Bloch, John M. ; Kim, Joyce J. ; Shahnavaz, Nikrad ; Raja, Shreya M. ; Patnana, Srikrishna V. ; Willingham, Field F. ; Keilin, Steven A. ; Cai, Qiang ; Christie, Jennifer A. ; Srinivasan, Shanthi ; Lin, Edward ; Davis, S. Scott ; Jain, Anand S.</creatorcontrib><description>Background
Esophagogastric junction obstruction (EGJO) post-fundoplication (PF) is difficult to identify with currently available tests. We aimed to assess the diagnostic accuracy of EGJ opening on functional lumen imaging probe (FLIP) and dilation outcome in FLIP-detected EGJO in PF dysphagia.
Methods
We prospectively collected data on PF patients referred to Esophageal Clinic over 18 months. EGJO diagnosis was made by (a) endoscopist’s description of a narrow EGJ/wrap area, (b) appearance of wrap obstruction or contrast/tablet retention on esophagram, or (c) EGJ-distensibility index (DI) < 2.8 mm
2
/mmHg on real-time FLIP. In patients with EGJO and dysphagia, EGJ dilation was performed to 20 mm, 30 mm, or 35 mm in a stepwise fashion. Outcome was assessed as % dysphagia improvement during phone call or on brief esophageal dysphagia questionnaire (BEDQ) score.
Results
Twenty-six patients were included, of whom 17 (65%) had a low EGJ-DI. No patients had a hiatal hernia greater than 3 cm. Dysphagia was the primary symptom in 17/26 (65%). In 85% (
κ
= 0.677) of cases, EGJ assessment (tight vs. open) was congruent between the combination of endoscopy (
n
= 26) and esophagram (
n
= 21) vs. EGJ-DI (
n
= 26) on FLIP. Follow-up data were available in 11 patients who had dilation based on a low EGJ-DI (4 with 20 mm balloon and 7 with ≥ 30 mm balloon). Overall, the mean % improvement in dysphagia was 60% (95% CI 37.7–82.3%,
p
= 0.0001). Nine out of 11 patients, including 6 out of 7 undergoing pneumatic dilation, had improvement ≥ 50% in dysphagia (mean % improvement 72.2%; 95% CI 56.1–88.4%,
p
= 0.0001).
Conclusions and inferences
Functional lumen imaging probe is an accurate modality for evaluating for EGJ obstruction PF. FLIP may be used to select patients who may benefit from larger diameter dilation.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-020-07941-6</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Dysphagia ; Esophagus ; Gastroenterology ; Gynecology ; Hepatology ; Medicine ; Medicine & Public Health ; Proctology ; Surgery</subject><ispartof>Surgical endoscopy, 2021-08, Vol.35 (8), p.4418-4426</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020</rights><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c352t-756fb050314aff006c1c3d2cdbe172c5b73529d6171812b9526fa6a86846aea63</citedby><cites>FETCH-LOGICAL-c352t-756fb050314aff006c1c3d2cdbe172c5b73529d6171812b9526fa6a86846aea63</cites><orcidid>0000-0002-7097-0446</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-020-07941-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-020-07941-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids></links><search><creatorcontrib>Samo, Salih</creatorcontrib><creatorcontrib>Mulki, Ramzi</creatorcontrib><creatorcontrib>Godiers, Marie L.</creatorcontrib><creatorcontrib>Obineme, Chuma G.</creatorcontrib><creatorcontrib>Calderon, Lucie F.</creatorcontrib><creatorcontrib>Bloch, John M.</creatorcontrib><creatorcontrib>Kim, Joyce J.</creatorcontrib><creatorcontrib>Shahnavaz, Nikrad</creatorcontrib><creatorcontrib>Raja, Shreya M.</creatorcontrib><creatorcontrib>Patnana, Srikrishna V.</creatorcontrib><creatorcontrib>Willingham, Field F.</creatorcontrib><creatorcontrib>Keilin, Steven A.</creatorcontrib><creatorcontrib>Cai, Qiang</creatorcontrib><creatorcontrib>Christie, Jennifer A.</creatorcontrib><creatorcontrib>Srinivasan, Shanthi</creatorcontrib><creatorcontrib>Lin, Edward</creatorcontrib><creatorcontrib>Davis, S. Scott</creatorcontrib><creatorcontrib>Jain, Anand S.</creatorcontrib><title>Utilizing functional lumen imaging probe in directing treatment for post-fundoplication dysphagia</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><description>Background
Esophagogastric junction obstruction (EGJO) post-fundoplication (PF) is difficult to identify with currently available tests. We aimed to assess the diagnostic accuracy of EGJ opening on functional lumen imaging probe (FLIP) and dilation outcome in FLIP-detected EGJO in PF dysphagia.
Methods
We prospectively collected data on PF patients referred to Esophageal Clinic over 18 months. EGJO diagnosis was made by (a) endoscopist’s description of a narrow EGJ/wrap area, (b) appearance of wrap obstruction or contrast/tablet retention on esophagram, or (c) EGJ-distensibility index (DI) < 2.8 mm
2
/mmHg on real-time FLIP. In patients with EGJO and dysphagia, EGJ dilation was performed to 20 mm, 30 mm, or 35 mm in a stepwise fashion. Outcome was assessed as % dysphagia improvement during phone call or on brief esophageal dysphagia questionnaire (BEDQ) score.
Results
Twenty-six patients were included, of whom 17 (65%) had a low EGJ-DI. No patients had a hiatal hernia greater than 3 cm. Dysphagia was the primary symptom in 17/26 (65%). In 85% (
κ
= 0.677) of cases, EGJ assessment (tight vs. open) was congruent between the combination of endoscopy (
n
= 26) and esophagram (
n
= 21) vs. EGJ-DI (
n
= 26) on FLIP. Follow-up data were available in 11 patients who had dilation based on a low EGJ-DI (4 with 20 mm balloon and 7 with ≥ 30 mm balloon). Overall, the mean % improvement in dysphagia was 60% (95% CI 37.7–82.3%,
p
= 0.0001). Nine out of 11 patients, including 6 out of 7 undergoing pneumatic dilation, had improvement ≥ 50% in dysphagia (mean % improvement 72.2%; 95% CI 56.1–88.4%,
p
= 0.0001).
Conclusions and inferences
Functional lumen imaging probe is an accurate modality for evaluating for EGJ obstruction PF. FLIP may be used to select patients who may benefit from larger diameter dilation.</description><subject>Abdominal Surgery</subject><subject>Dysphagia</subject><subject>Esophagus</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Proctology</subject><subject>Surgery</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kE1LxDAQhoMouK7-AU8BL16ikzRNm6MsfoHgxT2HNE3XLN22Ju1h_fVOXUHw4CmQed6XmYeQSw43HKC4TQBSSQYCGBRacqaOyILLTDAheHlMFqAzYAJHp-QspS0gr3m-IHY9hjZ8hm5Dm6lzY-g729J22vmOhp3dzIMh9pWnoaN1iB4R_BqjtyMyI236SIc-jQzjdT-0wdm5hNb7NLxj3p6Tk8a2yV_8vEuyfrh_Wz2xl9fH59XdC3NZLkZW5KqpIIeMS9s0AMpxl9XC1ZXnhXB5VSCma8ULXnJR6VyoxipbqlIq663KluT60Ivrfkw-jWYXkvNtazvfT8kImWldKJSD6NUfdNtPEQ9HKpcatBalQEocKBf7lKJvzBBRSdwbDma2bg7WDVo339bNvEV2CCWEu42Pv9X_pL4ARA-F0Q</recordid><startdate>20210801</startdate><enddate>20210801</enddate><creator>Samo, Salih</creator><creator>Mulki, Ramzi</creator><creator>Godiers, Marie L.</creator><creator>Obineme, Chuma G.</creator><creator>Calderon, Lucie F.</creator><creator>Bloch, John M.</creator><creator>Kim, Joyce J.</creator><creator>Shahnavaz, Nikrad</creator><creator>Raja, Shreya M.</creator><creator>Patnana, Srikrishna V.</creator><creator>Willingham, Field F.</creator><creator>Keilin, Steven A.</creator><creator>Cai, Qiang</creator><creator>Christie, Jennifer A.</creator><creator>Srinivasan, Shanthi</creator><creator>Lin, Edward</creator><creator>Davis, S. Scott</creator><creator>Jain, Anand S.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7097-0446</orcidid></search><sort><creationdate>20210801</creationdate><title>Utilizing functional lumen imaging probe in directing treatment for post-fundoplication dysphagia</title><author>Samo, Salih ; Mulki, Ramzi ; Godiers, Marie L. ; Obineme, Chuma G. ; Calderon, Lucie F. ; Bloch, John M. ; Kim, Joyce J. ; Shahnavaz, Nikrad ; Raja, Shreya M. ; Patnana, Srikrishna V. ; Willingham, Field F. ; Keilin, Steven A. ; Cai, Qiang ; Christie, Jennifer A. ; Srinivasan, Shanthi ; Lin, Edward ; Davis, S. Scott ; Jain, Anand S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c352t-756fb050314aff006c1c3d2cdbe172c5b73529d6171812b9526fa6a86846aea63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Abdominal Surgery</topic><topic>Dysphagia</topic><topic>Esophagus</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Proctology</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Samo, Salih</creatorcontrib><creatorcontrib>Mulki, Ramzi</creatorcontrib><creatorcontrib>Godiers, Marie L.</creatorcontrib><creatorcontrib>Obineme, Chuma G.</creatorcontrib><creatorcontrib>Calderon, Lucie F.</creatorcontrib><creatorcontrib>Bloch, John M.</creatorcontrib><creatorcontrib>Kim, Joyce J.</creatorcontrib><creatorcontrib>Shahnavaz, Nikrad</creatorcontrib><creatorcontrib>Raja, Shreya M.</creatorcontrib><creatorcontrib>Patnana, Srikrishna V.</creatorcontrib><creatorcontrib>Willingham, Field F.</creatorcontrib><creatorcontrib>Keilin, Steven A.</creatorcontrib><creatorcontrib>Cai, Qiang</creatorcontrib><creatorcontrib>Christie, Jennifer A.</creatorcontrib><creatorcontrib>Srinivasan, Shanthi</creatorcontrib><creatorcontrib>Lin, Edward</creatorcontrib><creatorcontrib>Davis, S. Scott</creatorcontrib><creatorcontrib>Jain, Anand S.</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Samo, Salih</au><au>Mulki, Ramzi</au><au>Godiers, Marie L.</au><au>Obineme, Chuma G.</au><au>Calderon, Lucie F.</au><au>Bloch, John M.</au><au>Kim, Joyce J.</au><au>Shahnavaz, Nikrad</au><au>Raja, Shreya M.</au><au>Patnana, Srikrishna V.</au><au>Willingham, Field F.</au><au>Keilin, Steven A.</au><au>Cai, Qiang</au><au>Christie, Jennifer A.</au><au>Srinivasan, Shanthi</au><au>Lin, Edward</au><au>Davis, S. Scott</au><au>Jain, Anand S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Utilizing functional lumen imaging probe in directing treatment for post-fundoplication dysphagia</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><date>2021-08-01</date><risdate>2021</risdate><volume>35</volume><issue>8</issue><spage>4418</spage><epage>4426</epage><pages>4418-4426</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Esophagogastric junction obstruction (EGJO) post-fundoplication (PF) is difficult to identify with currently available tests. We aimed to assess the diagnostic accuracy of EGJ opening on functional lumen imaging probe (FLIP) and dilation outcome in FLIP-detected EGJO in PF dysphagia.
Methods
We prospectively collected data on PF patients referred to Esophageal Clinic over 18 months. EGJO diagnosis was made by (a) endoscopist’s description of a narrow EGJ/wrap area, (b) appearance of wrap obstruction or contrast/tablet retention on esophagram, or (c) EGJ-distensibility index (DI) < 2.8 mm
2
/mmHg on real-time FLIP. In patients with EGJO and dysphagia, EGJ dilation was performed to 20 mm, 30 mm, or 35 mm in a stepwise fashion. Outcome was assessed as % dysphagia improvement during phone call or on brief esophageal dysphagia questionnaire (BEDQ) score.
Results
Twenty-six patients were included, of whom 17 (65%) had a low EGJ-DI. No patients had a hiatal hernia greater than 3 cm. Dysphagia was the primary symptom in 17/26 (65%). In 85% (
κ
= 0.677) of cases, EGJ assessment (tight vs. open) was congruent between the combination of endoscopy (
n
= 26) and esophagram (
n
= 21) vs. EGJ-DI (
n
= 26) on FLIP. Follow-up data were available in 11 patients who had dilation based on a low EGJ-DI (4 with 20 mm balloon and 7 with ≥ 30 mm balloon). Overall, the mean % improvement in dysphagia was 60% (95% CI 37.7–82.3%,
p
= 0.0001). Nine out of 11 patients, including 6 out of 7 undergoing pneumatic dilation, had improvement ≥ 50% in dysphagia (mean % improvement 72.2%; 95% CI 56.1–88.4%,
p
= 0.0001).
Conclusions and inferences
Functional lumen imaging probe is an accurate modality for evaluating for EGJ obstruction PF. FLIP may be used to select patients who may benefit from larger diameter dilation.</abstract><cop>New York</cop><pub>Springer US</pub><doi>10.1007/s00464-020-07941-6</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-7097-0446</orcidid></addata></record> |
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| ispartof | Surgical endoscopy, 2021-08, Vol.35 (8), p.4418-4426 |
| issn | 0930-2794 1432-2218 |
| language | eng |
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| source | SpringerLink Journals - AutoHoldings |
| subjects | Abdominal Surgery Dysphagia Esophagus Gastroenterology Gynecology Hepatology Medicine Medicine & Public Health Proctology Surgery |
| title | Utilizing functional lumen imaging probe in directing treatment for post-fundoplication dysphagia |
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