Functional Luminal Imaging Probe (FLIP) in the Management of Pediatric Esophageal Disorders.

BACKGROUND Functional luminal imaging probe (FLIP) measures pressure-geometry relationships of digestive luminal space. When used in esophageal disorders, it provides several luminal parameters that help better understand the pathophysiology. Data about the potential utility of FLIP in pediatrics are scarce and there is no standardized use in children. We aim to describe the use of FLIP in our center, its safety, feasibility, and clinical impact in esophageal disorders in children. METHODS Consecutive FLIP recordings performed at the CHU-Sainte-Justine, Montreal, Canada between February 2018 and January 2021 were extracted. A chart review was conducted for demographics and medical history. Symptomatology after the procedure was evaluated with validated dysphagia scores. 19 patients were included (11 girls, median age 16 years, range 3.2-19.6) with achalasia (n = 5), post Heller's myotomy dysphagia (n = 3); esophagogastric junction outflow obstruction (EGJOO) (n = 3); congenital esophageal stenosis (n = 2); post esophageal atresia repair stricture (n = 3), post-fundoplication dysphagia (n = 3). There was no significant correlation between integrated relaxation pressure measured with high resolution manometry and distensibility index (DI). The use of FLIP made it possible to differentiate between dysphagia related to an esophageal obstruction (DI ≤ 2.8 mm2/mmHg) and dysphagia without major motility disorder (DI > 2.8 mm2/mmHg) that guided the indication for dilation. FLIP led to a change in management in 47% of the patients. Forty-seven percent of the patients were symptom free at the time of the evaluation.Conclusions & Inferences: FLIP provides key esophageal luminal values and therefore can play an important role in pediatric esophageal disorders management.