Han Zhang, MD1, Hassan Alsabbak, MD2, Eric Pasman, MD3, Matthew Skinner, MD4, Ahmad M. Mansour, MD5, Fouad J. Moawad, MD1 1Scripps Clinic, San Diego, CA; 2Scripps Green Hospital, La Jolla, CA; 3Naval Medical Center San Diego, San Diego, CA; 4Scripps Green - Scripps Clinic, San Diego, CA; 5Scripps Clinic, La Jolla, CA
Introduction: Barium esophagram is traditionally used to assess structural and functional characteristics of the esophagus, whereas high-resolution manometry (HRM) is the gold standard for characterizing diseases of esophageal motility. Endoscopic functional lumen imaging probe (EndoFLIP) is a newer technology performed during upper endoscopy that can assess the esophagogastric junction distensibility, esophageal diameter, and direction of esophageal peristalsis. We aimed to examine the concordance between barium esophagram, HRM, and EndoFLIP among patients with esophageal symptoms.
Methods: We enrolled 150 consecutive patients referred for esophageal symptoms undergoing FLIP panometry using a 16-cm probe during endoscopy at a single center. We measured distensibility index (DI) and contractility (RAC, RRC, absent peristalsis) during step-wise volumetric distension every 10 ml up to 60 ml. The results of EndoFLIP were compared to prior results of barium esophagram and HRM. Concordance was assessed by Fleiss’ Kappa using R Studio.
Results: The most common indication for the study was dysphagia (73%). The median patient age was 62 years (17-89). The most common diagnoses by EndoFLIP were EGJ outflow obstruction (20%), achalasia (19%), and esophageal spasm (12%). 48 patients underwent all three diagnostic tests with a kappa value of 0.56 (p< 0.05), indicating moderate agreement between modalities. For achalasia, agreement between all three modalities was near perfect (k=0.84). For EGJ outflow obstruction and esophageal spasm, agreement was moderate (k=0.56 and k=0.55 respectively). There was also moderate concordance among normal patients (k=0.49). 70 patients underwent both EndoFLIP and HRM, concordance between these two modalities was substantial at a kappa of 0.65 (p< 0.05). Of the patients undergoing these two modalities, agreement for achalasia was near perfect (k=0.89), substantial for EGJ outflow (k=0.63), and moderate for esophageal spam (k=0.58).
Discussion: We found good concordance in diagnoses comparing 3 modalities of testing. This concordance is even more substantial when comparing EndoFLIP to HRM. Given that some patients may not tolerate HRM, EndoFLIP provides a practical alternative that can be completed during a sedated esophagogastroduodenoscopy.
Disclosures: Han Zhang indicated no relevant financial relationships. Hassan Alsabbak indicated no relevant financial relationships. Eric Pasman indicated no relevant financial relationships. Matthew Skinner indicated no relevant financial relationships. Ahmad Mansour indicated no relevant financial relationships. Fouad Moawad indicated no relevant financial relationships.
Han Zhang, MD1, Hassan Alsabbak, MD2, Eric Pasman, MD3, Matthew Skinner, MD4, Ahmad M. Mansour, MD5, Fouad J. Moawad, MD1. P0288 - Concordance in Diagnoses Between Barium Esophagram, High-resolution Manometry, and EndoFLIP, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.