C0211 - Anesthesia Choice Can Affect EndoFLIP^® Measurements and Thereby Misdiagnose Esophageal Motility Disorders

Award: Presidential Poster Award

Jennifer L. Grossman, MD¹, Samantha Menegas, BS², David U. Lee, MD¹, Raymond E. Kim, MD^2
1University of Maryland Medical Center, Baltimore, MD; ²University of Maryland School of Medicine, Baltimore, MD

Introduction: Endoscopic functional lumen imaging probe (EndoFLIP®) is utilized during endoscopy to diagnose esophageal motility disorders (EMDs). EndoFLIP uses a balloon inflated to different sizes to measure the pressure (P) and diameter (D) of the lower esophageal sphincter and the distensibility index (DI) at the gastroesophageal junction. These parameters are crucial for differentiating spastic EMDs, which have high P and low D and DI, from non-spastic EMDs, which have lower P and higher D and DI. Sevoflurane (sevo) is used for general anesthesia. Propofol (prop) is used for monitored anesthesia care. Sevo induces a stronger neuromuscular blockade than prop. This study compares the effect of these anesthetics on EndoFLIP measurements.

Methods: Patients with non-spastic (Type 1) achalasia, spastic (Types 2 and 3) achalasia, or Jackhammer esophagus (JE) who underwent peroral endoscopic myotomy at the University of Maryland Medical Center between 2/2017 and 2/2022 were retrospectively reviewed. Those who had EndoFLIP while sedated with prop and sevo were included. The differences in P, D, and DI using prop vs sevo (PS-P, SP-D, SP-DI) with a 30mL and 60mL balloon were obtained. The differences were divided into terciles and compared between diagnoses.

Results: 49 patients were included. 19 (39%) had Type 1, 21 (43%) had Type 2 or 3, and 9 (18%) had JE. Sevo induced lower P and higher D and DI on average. Compared to all other diagnoses, Type 1 correlated with the lower tercile PS-P at 60mL (aOR 10.0, 95%CI 2.23-45.3, p=0.003) and inversely correlated with the higher tercile PS-P at 60mL (aOR 0.12 95%CI 0.02-0.70, p=0.02) and 30mL (aOR 0.14, 95%CI 0.02-0.76, p=0.02). Types 2 and 3 correlated with the higher tercile PS-P at 30mL (aOR 6.29, 95%CI 1.03-38.4, p=0.05) and inversely correlated with the lower tercile PS-P at 60mL (aOR 0.16, 95%CI 0.03-0.78, p=0.02) compared to Type I. JE correlated with the higher tercile PS-P at 30mL (aOR 18.8, 95%CI 1.40-252, p=0.03) compared to Type I.

Discussion: Esophageal pressure measured by EndoFLIP was significantly reduced when patients were sedated with sevo vs prop. This affects the diagnostic accuracy of the EndoFLIP. The most important distinguishing factor for Type 1 achalasia vs spastic esophageal disorder is the pressure and spasm of the esophageal body. Thus using sevo for diagnostic EndoFLIP can potentially cause spastic achalasia to be misdiagnosed as Type 1 achalasia. Therefore, prop should be considered over sevo for sedation during the diagnostic test.


Disclosures:


Jennifer L. Grossman, MD¹, Samantha Menegas, BS², David U. Lee, MD¹, Raymond E. Kim, MD². C0211 - Anesthesia Choice Can Affect EndoFLIP^® Measurements and Thereby Misdiagnose Esophageal Motility Disorders, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.