Devices for esophageal function testing

Rahul Pannala; Kumar Krishnan; Rabindra R Watson; Marcelo F Vela; Barham K Abu Dayyeh; Amit Bhatt; Manoop S Bhutani; Juan Carlos Bucobo; Vinay Chandrasekhara; Andrew P Copland; Pichamol Jirapinyo; Nikhil A Kumta; Ryan J Law; John T Maple; Joshua Melson; Mansour A Parsi; Erik F Rahimi; Monica Saumoy; Amrita Sethi; Guru Trikudanathan; Arvind J Trindade; Julie Yang; David R Lichtenstein

doi:10.1016/j.vgie.2021.08.012

Devices for esophageal function testing

VideoGIE. 2021 Oct 22;7(1):1-20. doi: 10.1016/j.vgie.2021.08.012. eCollection 2022 Jan.

Authors

Rahul Pannala¹, Kumar Krishnan², Rabindra R Watson³, Marcelo F Vela¹, Barham K Abu Dayyeh⁴, Amit Bhatt⁵, Manoop S Bhutani⁶, Juan Carlos Bucobo⁷, Vinay Chandrasekhara⁴, Andrew P Copland⁸, Pichamol Jirapinyo⁹, Nikhil A Kumta¹⁰, Ryan J Law⁴, John T Maple¹¹, Joshua Melson¹², Mansour A Parsi¹³, Erik F Rahimi¹⁴, Monica Saumoy¹⁵, Amrita Sethi¹⁶, Guru Trikudanathan¹⁷, Arvind J Trindade¹⁸, Julie Yang¹⁹, David R Lichtenstein²⁰

Affiliations

¹ Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona.
² Division of Gastroenterology, Department of Internal Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts.
³ Department of Gastroenterology, Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California.
⁴ Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
⁵ Department of Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, Ohio.
⁶ Department of Gastroenterology Hepatology and Nutrition, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
⁷ Division of Gastroenterology and Hepatology, Stony Brook Medicine, Stony Brook, New York.
⁸ Division of Gastroenterology and Hepatology, University of Virginia Health Systems, Charlottesville, Virginia.
⁹ Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts.
¹⁰ Division of Gastroenterology, Mount Sinai Hospital, New York, New York.
¹¹ Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
¹² Division of Digestive Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois.
¹³ Division of Gastroenterology and Hepatology, University of Tennessee Health Sciences Center, Memphis, Tennessee.
¹⁴ Department of Gastroenterology, Baylor Scott & White Health, Lakeway, Texas.
¹⁵ Department of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania.
¹⁶ Department of Digestive and Liver Diseases, New York-Presbyterian Medical Center/Columbia University Medical Center, New York, New York.
¹⁷ Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota.
¹⁸ Department of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, New Hyde Park, New York.
¹⁹ Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
²⁰ Division of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.

Abstract

Background and aims: Esophageal function testing is an integral component of the evaluation of refractory GERD and esophageal motility disorders. This review summarizes the current technologies available for esophageal function testing, including the functional luminal imaging probe (FLIP), high-resolution esophageal manometry (HRM), and multichannel intraluminal impedance (MII) and pH monitoring.

Methods: We performed a MEDLINE, PubMed, and MAUDE database literature search to identify pertinent clinical studies through March 2021 using the following key words: esophageal manometry, HRM, esophageal impedance, FLIP, MII, and esophageal pH testing. Technical data were gathered from traditional and web-based publications, proprietary publications, and informal communications with pertinent vendors. The report was drafted, reviewed, and edited by the American Society for Gastrointestinal Endoscopy Technology Committee and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy.

Results: FLIP is a high-resolution impedance planimetry system used for pressure and dimension measurement in the esophagus, pylorus, and anal sphincter. FLIP provides complementary information to HRM for esophageal motility disorders, especially achalasia. The Chicago classification, based on HRM data, is a widely adopted algorithmic scheme used to diagnose esophageal motility disorders. MII detects intraluminal bolus movement and, combined with pH measurement or manometry, provides information on acid and non-acid gastroesophageal reflux and bolus transit in patients with refractory GERD and for preoperative evaluation for anti-reflux procedures.

Conclusions: Esophageal function testing techniques (FLIP, HRM, and MII-pH) have diagnostic and prognostic value in the evaluation of esophageal motility disorders and refractory GERD. Newer technologies and classification systems have enabled an increased understanding of these diseases.

Keywords: AET, acid exposure time; ASGE, American Society for Gastrointestinal Endoscopy; BMI, body mass index; CC, Chicago classification; CD, contractile deceleration; CSA, cross-sectional area; DI, distensibility index; DP, distensibility plateau; DRI, dysphagia risk index; EGJ, esophagogastric junction; EGJOO, esophagogastric junction outflow obstruction; EM, esophageal manometry; EPT, esophageal pressure topography plots; EoE, eosinophilic esophagitis; FLIP, functional luminal imaging probe; HRM, high-resolution esophageal manometry; IEM, ineffective esophageal motility; IRP, integrated relaxation pressure; LES, lower esophageal sphincter; LHM, laparoscopic Heller myotomy; MII, multichannel intraluminal impedance; MRS, multiple rapid swallows; MSA, magnetic sphincter augmentation; NOD, nonobstructive dysphagia; POEM, peroral endoscopic myotomy; PPI, proton pump inhibitors; SAP, symptom association probability; SI, Symptom index; UES, upper esophageal sphincter.