Northwestern University Feinberg School of Medicine Chicago, IL, United States
Award: Presidential Poster Award
Aditi Simlote, MD, Melina Masihi, MD, PhD, Jacqueline E. Prescott, BS, John E. Pandolfino, MD, Dustin Carlson, MD Northwestern University Feinberg School of Medicine, Chicago, IL
Introduction: Functional luminal imaging probe (FLIP) Panometry evaluates esophageal motility in response to sustained distension, i.e. esophagogastric junction (EGJ) opening and secondary peristalsis. FLIP is typically performed during sedated endoscopy and its motility evaluation results parallel those from high-resolution manometry (i.e. primary peristalsis) performed on awake patients. This study aimed to examine the impact of moderate sedation on FLIP Panometry results in healthy, asymptomatic volunteers.
Methods: Twelve asymptomatic, healthy volunteers (mean (SD) age 31 (7) years; 9 females) completed 16 cm FLIP during endoscopy with moderate sedation (midazolam, range 7-10mg, and fentanyl, range 150-200 mcg), “sedated”, and again on a separate day while awake. Prior to awake FLIP study, viscous lidocaine was gargled and spit. The FLIP study included 10-ml stepwise volumetric distension from 40ml to 70ml FLIP fill volumes. FLIP Panometry parameters, including EGJ-distensibility index (DI) during the 60ml fill volume, maximum EGJ diameter, FLIP pressure, and the contractile response to distension (i.e. secondary peristalsis) were analyzed using a customized software program.
Results: All 12 subjects had antegrade contractions in both the sedated and awake FLIP Panometry studies. A repetitive antegrade contraction (RAC) pattern was induced in 11/12 (92%) sedated studies and 8/12 (75%) awake studies (P=0.250). The rate of antegrade contractions within the RAC pattern was similar between sedated and awake studies (Figure; P=0.180). The EGJ-DI was lower (P=0.006) related to greater 60-ml FLIP pressure (P=0.001) in the sedated than the awake studies; the maximum EGJ diameters were similar (P=0.999; Figure). None of the subjects had a change in classification of EGJ opening between sedated and awake studies, i.e. all had normal EGJ opening (NEO) and normal motility in both settings.
Discussion: Clinically significant changes did not occur between FLIP Panometry studies performed awake versus those performed in the standard manner with moderate sedation among asymptomatic, healthy volunteers. Subject discomfort may create artifact and limit performance of awake FLIP studies. Sedated FLIP provides a reliable and well tolerated method to assess the esophageal response to distension and secondary peristalsis.
Figure: Comparison of FLIP Panometry metrics between FLIP studies performed under moderate sedation (“sedated”) versus awake. Each colored line represents an individual subject. Black bars represent mean values. a- The rate of RACs (antegrade contractions per minute) was assessed only in studies in which the RAC pattern, defined by a regular rhythm of contractions, occurred.
Aditi Simlote indicated no relevant financial relationships.
Melina Masihi indicated no relevant financial relationships.
Jacqueline Prescott indicated no relevant financial relationships.
Aditi Simlote, MD, Melina Masihi, MD, PhD, Jacqueline E. Prescott, BS, John E. Pandolfino, MD, Dustin Carlson, MD. P2409 - The Esophageal Response to Distension on FLIP Panometry Is Minimally Changed by Moderate Sedation in Healthy, Asymptomatic Volunteers, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.