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J Pediatr Gastroenterol Nutr. 2020 Feb 11. doi: 10.1097/MPG.0000000000002658. [Epub ahead of print]

Functional Luminal Imaging Probe Assessment in Post-Fundoplication Patients Changes Management Beyond Manometry.

Author information

1
Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115.
2
GI Care for Kids, 993D Johnson Ferry Road, N Suite 440, Atlanta, GA 30342.
3
Neurogastroenterology and Motility Program, Children's Healthcare of Atlanta.

Abstract

OBJECTIVES:

Fundoplication is a commonly performed pediatric surgery but the surgery can result in nonspecific symptoms that merit further evaluation. The goal of this study was to determine the utility of Functional Luminal Imaging Probe (FLIP) compared to high resolution manometry with impedance (HRIM) in the evaluation of fundoplication symptoms.

METHODS:

We reviewed the FLIP and HRIM tracings of symptomatic fundoplication patients. We compared FLIP results of fundoplication patients to those of pediatric achalasia and control patients. We also compared the role of FLIP to HRIM in clinical decision making and clinical outcomes.

RESULTS:

EGJ distensibilities of fundoplication patients ranged from 0.6 to 8.2 mm/mm Hg. Because of the different pediatric patient sizes (8.9 to 73.5 kg), balloon size inflations varied but, after adjusting balloon fill volume by weight, there was a linear relationship between inflation and distensibility. When compared to control patients and achalasia patients, distensibilities of fundoplication patients were lower than control patients and higher than achalasia patients (p = 0.0001). Patients who had an EGJ intervention had a mean EGJ distensibility of 2.3 ± 1.1 mm/mm Hg compared to 5.1 ± 1.6 in mm/mm Hg in medically managed patients (p = 0.0001). Patients who had an EGJ intervention had a mean IRP of 13.9 ± 6.1 mm Hg compared to medically managed patients who had a mean IRP of 9.9 ± 3.9 mm Hg (p = 0.3).

CONCLUSIONS:

In conclusion, we show FLIP may provide additional insight into EGJ physiology in symptomatic fundoplication patients and complements HRIM.

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