Normal Functional Luminal Imaging Probe Panometry Findings Associate With Lack of Major Esophageal Motility Disorder on High-Resolution Manometry.

Abstract Background & Aims A normal esophageal response to distension on functional luminal imaging probe (FLIP) panometry during endoscopy might indicate normal esophageal motor function. We aimed to investigate the correlation of normal FLIP panometry findings with esophageal high-resolution manometry (HRM) and outcomes of discrepant patients. Methods We performed a retrospective study using data from a registry of patients who completed FLIP during sedated endoscopy. We identified 111 patients with normal FLIP panometry findings (mean age 42, 69% female) and corresponding HRM data. A normal FLIP panometry was defined as esophagogastric junction (EGJ) distensibility index greater than 3.0 mm2/mmHg, an absence of repetitive retrograde contractions, and a repetitive antegrade contraction pattern that met the Rule-of-6s. HRM findings were classified by Chicago classification system v3.0. Results HRM results were classified as normal motility in 78 patients (70%), ineffective esophageal motility in 10 patients (9%), EGJ outflow obstruction in 20 patients (18%), and 3% as other. In patients with EGJ outflow obstruction based on HRM, the integrated relaxation pressure normalized on adjunctive swallows in 16/20 patients (80%), and in 8/9 patients (88%) who completed barium esophagram had normal barium clearance. Thus, although 23/111 patients (21%) with normal FLIP panometry had abnormal HRM findings, these HRMs were often considered to be false positive or equivocal results. All patients with an abnormal result from HRM were treated conservatively. Conclusions In a retrospective cohort study, we found that patients with normal FLIP panometry results did not have a clinical impression of a major esophageal motor disorder. Normal FLIP panometry results can exclude esophageal motility disorders at the time of endoscopy, possibly negating the need for HRM in select patients.