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Neurogastroenterol Motil 2022 Jun 5:e14419. Epub 2022 Jun 5.

Medtronic, Minneapolis, Minnesota, USA.

Background: The functional lumen imaging probe (Endoflip™) is increasingly used for evaluation of patients with esophageal symptoms. To improve the interpretation of Endoflip™ in clinical practice, normative values with appropriate cut-off values are required.

Methods: Original clinical studies describing Endoflip™ use for measurements of esophageal motility in healthy adults were considered. Read More

J Pediatr Surg 2022 May 10. Epub 2022 May 10.

Emory-Children's Pediatric Institute, Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States.

Introduction: Functional lumen imaging probe (EndoFLIP) is a diagnostic technology that assesses esophageal cross-sectional area via impedance planimetry during controlled volumetric distention. The purpose of this study is to evaluate the utility of EndoFLIP intraoperatively during laparoscopic esophagomyotomy.

Methods: We performed a retrospective cohort study reviewing all patients undergoing EndoFLIP assisted laparoscopic esophagomyotomy for achalasia between January and December 2021 (n = 10). Read More

Clin Nucl Med 2022 May 19. Epub 2022 May 19.

From the Department of Nuclear Medicine and Molecular Imaging, Emory University School of Medicine, Atlanta, GA.

Abstract: An 82-year-old man underwent outpatient nuclear medicine gastric-emptying scintigraphy (GES) for dysphagia and regurgitation. Standard solid-meal GES showed significant elongated tracer retention with calculated 96% retention rate at 3 hours, with a presumed diagnosis of delayed gastric emptying. Subsequent CT of the chest and abdomen and upper gastrointestinal fluoroscopy instead showed normal size and function of the stomach but an enormously dilated esophagus with food debris, compatible with achalasia. Read More

Nat Rev Dis Primers 2022 05 5;8(1):28. Epub 2022 May 5.

Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.

Achalasia is a rare disorder of the oesophageal smooth muscle characterized by impaired relaxation of the lower oesophageal sphincter (LES) and absent or spastic contractions in the oesophageal body. The key pathophysiological mechanism is loss of inhibitory nerve function that probably results from an autoimmune attack targeting oesophageal myenteric nerves through cell-mediated and, possibly, antibody-mediated mechanisms. Achalasia incidence and prevalence increase with age, but the disorder can affect all ages and both sexes. Read More

J Gen Fam Med 2022 May 14;23(3):189-190. Epub 2022 Jan 14.

Department of General Medicine Oita University Faculty of Medicine Yufu Oita Japan.

Our case serves as a reminder that clinicians should pay attention to the presence of esophageal diseases in patients with lung abscesses. The esophagus should be evaluated during pulmonary CT imaging. Read More

Surg Endosc 2022 May 3. Epub 2022 May 3.

Department of Surgery, NorthShore University Health System, 2650 Ridge Ave, GCSI Suite B665, Evanston, IL, 60201, USA.

Background: Numerous studies show changes in functional lumen imaging probe (FLIP) measurements after myotomy during peroral endoscopic myotomy (POEM), but few report on FLIP measurements at follow-up esophagogastroduodenoscopy (EGD). The purpose of this study was to compare perioperative FLIP measurements to those at follow-up EGD.

Methods: Patients who underwent POEM with FLIP in the operating room and POEM patients who had EGD with FLIP at follow-up were included. Read More

Int J Med Robot 2022 Apr 26:e2411. Epub 2022 Apr 26.

Department of Robotic General Surgery, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy.

Background: The robotic Heller-Dor (RHD) procedure for oesophageal achalasia (EA) is safe and effective. We aim to evaluate the intraoperative use of fluorescence imaging, as an alternative means to intraoperative endoscopy, to assess myotomy at the end of the procedure.

Methods: Thirty-four patients affected with EA underwent RHD. Read More

Gastroenterol Hepatol (N Y) 2021 Oct;17(10):468-475

University of South Florida Morsani College of Medicine, Tampa, Florida.

High-resolution manometry (HRM) has revolutionized esophageal motility testing, and the evolving Chicago Classification has been critical in codifying HRM metrics and definitions of old and new motility disorders. The latest Chicago Classification (version 4.0) is the result of a working group of 52 members (10 women) from 20 countries. Read More

Intern Med 2022 1;61(7):943-949. Epub 2022 Apr 1.

Division of Gastroenterology, Niigata University Faculty of Medical Graduate School of Medical and Dental Science, Japan.

Objective Esophageal diverticulum is rare, and the concomitance of esophageal motility disorders (EMDs) and the efficacy of novel endoscopic treatment have not been investigated in Japan. Methods An examination including high-resolution manometry (HRM) was performed for patients with both EMDs and epiphrenic diverticulum. EMD-related epiphrenic diverticulum and Zenker's diverticulum were treated using salvage peroral endoscopic myotomy (s-POEM) and endoscopic diverticulotomy, respectively. Read More

Anesth Pain Med (Seoul) 2022 Apr 8;17(2):239-244. Epub 2022 Mar 8.

Department of Anesthesiology and Pain Medicine, Severance Hospital and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.

Background: Intraoperative pulmonary aspiration is a rare but potentially fatal complication associated with various risk factors. Preoperative recognition of these risk factors can prevent aspiration events during general anesthesia or facilitate prompt corrective measures in patients experiencing this complication.

Case: A 70-year-old female patient with hypertension underwent bilateral total knee arthroplasty under general anesthesia. Read More

Gastrointest Endosc 2022 Mar 9. Epub 2022 Mar 9.

Division of Gastroenterology, University of California San Diego, San Diego, California, USA.

Achalasia is an esophageal motility disorder characterized by impaired lower esophageal sphincter (LES) relaxation and failed peristalsis. Common clinical manifestations include dysphagia to solid and liquid foods, chest pain, regurgitation, and weight loss, resulting in significant morbidity and healthcare burden. Historically, surgical Heller myotomy and pneumatic dilation were the first-line therapeutic options for achalasia. Read More

Anaesth Intensive Care 2022 Jul 11;50(4):320-324. Epub 2022 Mar 11.

Department of Anaesthesia, Queen Elizabeth Hospital, Adelaide, Australia.

A 77-year-old lady with a laparoscopic adjustable gastric band (LAGB), implanted 12 years earlier for obesity, developed an unusual but almost fatal complication, characterised by dysphonia and stridor within minutes and a tensely swollen anterior neck. The condition mimicked haemorrhage into the subcutaneous tissues of the neck, and the airway was secured with an awake fibreoptic intubation. Subsequent computed tomography imaging of the abdomen and chest revealed megaoesophagus with dilatation up to 7 cm, proximal to the gastric band. Read More

Korean J Gastroenterol 2022 Feb;79(2):66-71

Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.

The Chicago Classification is being revised continuously for the accurate diagnosis of esophageal peristaltic disorders in which the etiology is unclear, and the disease behavior is heterogeneous. The ver. 4. Read More

Korean J Gastroenterol 2022 Feb;79(2):61-65

Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Achalasia is a common esophageal motility disorder characterized by inappropriate relaxation of the lower esophageal sphincter and a loss of normal peristalsis in the esophageal body. The newly suggested Chicago Classification ver. 4. Read More

World J Surg 2022 Jul 25;46(7):1542-1546. Epub 2022 Feb 25.

Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, GCSI Suite B665, Evanston, IL, 60201, USA.

Background: Peroral endoscopic myotomy (POEM) utilizes the principles of natural orifice transluminal surgery to create an operative tunnel within the submucosal space, perform an endoluminal esophagogastromyotomy, and ultimately mitigate the progressive symptoms of achalasia. POEM is an innovative minimally invasive technique increasing in popularity and clinical significance as an effective treatment for achalasia and other disorders of spastic esophageal motility.

Methods: A comprehensive literature review was performed regarding the procedure, outcomes, and technical advancements in POEM. Read More

World J Surg 2022 Jul 23;46(7):1516-1521. Epub 2022 Feb 23.

Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, Azienda Ospedale Università di Padova, University of Padova, Padua, Italy.

A precise diagnosis is key to the successful treatment of achalasia. Barium swallow, upper endoscopy and high-resolution manometry provide the necessary information about a patient's anatomy, absence of other diseases, and type of achalasia (I, II, III). High-resolution manometry also has prognostic value, the best results of treatment being obtained in type II achalasia according to the Chicago classification. Read More

BMC Gastroenterol 2022 Feb 21;22(1):74. Epub 2022 Feb 21.

Department of Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.

Background: Intrabolus pressure (IBP) recorded by high-resolution manometry (HRM) portrays the compartmentalized force on a bolus during esophageal peristalsis. HRM may be a reliable screening tool for esophageal dysmotility in patients with elevated average maximum IBP (AM-IBP). Timed barium esophagram (TBE) is a validated measure of esophageal emptying disorders, such as esophagogastric junction outflow obstruction and achalasia. Read More

Gastrointest Endosc 2022 Jul 9;96(1):9-17.e3. Epub 2022 Feb 9.

Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA.

Background And Aims: A small percentage of patients with esophageal dysmotility disorders (EDDs) fail to improve or relapse after management by laparoscopic Heller myotomy (LHM) and peroral endoscopic myotomy (POEM). In this study, we aimed to describe the role of functional luminal imaging probe (FLIP) in identifying patients who might benefit from lower esophageal sphincter (LES)-directed retreatment.

Methods: This was a retrospective study at 6 tertiary care centers (United States, 4; Europe, 1; Asia, 1) between January 2015 and April 2021 involving patients with prior failed myotomy. Read More

World J Surg 2022 Jul 10;46(7):1547-1553. Epub 2022 Feb 10.

Department of Surgery, University of Virginia, Charlottesville, VA, USA.

Background: Epiphrenic diverticulum (ED) is a pulsion pseudodiverticulum found in the distal 10 cm of the esophagus. Motility disorders are present in the majority of patients with ED explaining the pathophysiology of this rare disease. Achalasia is the most common underlying disorder. Read More

J Pediatr Gastroenterol Nutr 2022 Apr 3;74(4):523-528. Epub 2022 Feb 3.

Division of Gastroenterology, Hepatology & Nutrition, Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, MA.

Background: Functional luminal imaging probes (FLIP) have been used by multiple centers to assess esophagogastric junction (EGJ) function in patients at risk for esophageal obstruction but its role in diagnosing peristaltic disorders is less well studied. In particular, there are no studies comparing the sensitivity of FLIP to diagnose motility abnormalities and impaired bolus transit by high-resolution esophageal manometry with impedance.

Methods: We prospectively recruited 42 patients undergoing high-resolution esophageal manometry with impedance (HRIM) who also underwent FLIP between 2018 and 2020. Read More

Radiographics 2022 Mar-Apr;42(2):379-396. Epub 2022 Jan 28.

From the Department of Radiology (H.V.N., S.P.D., C.G.R.) and Department of Gastroenterology and Hepatology (A.S.), Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19123; Division of Gastroenterology and Hepatology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ (H.S.); and Department of Radiology, Westchester Medical Center, Valhalla, NY (C.V.).

As the field of interventional endoscopy advances, conditions that were once treated with surgery are increasingly being treated with advanced endoscopy. Endoscopy is now used for treatment of achalasia, bariatric procedures for obesity; resection of early-stage malignancies in the gastrointestinal tract; and placement of lumen-apposing metal stents in the treatment of biliary obstruction, gastric outlet obstruction, cholecystitis, and drainage of nonpancreatic-related fluid collections or abscesses. Knowledge of the novel terminology, procedural details, expected postintervention imaging findings, and potential complications is vital for radiologists because these procedures are rapidly becoming more mainstream in daily practice. Read More

Neurogastroenterol Motil 2022 03 24;34(3):e14322. Epub 2022 Jan 24.

GI Physiology Unit, University College London Hospital, London, UK.

Background: Timed barium swallow (TBS) is a recommended ancillary investigation in evaluation of esophagogastric junction (EGJ) obstruction, yet there are little data comparing esophageal stasis across subtypes.

Methods: A retrospective cohort study was performed. All type III achalasia diagnosed between November 2016 and November 2020 were included, along with matched numbers of consecutive types I and II and conclusive EGJOO cases with concurrent TBS evaluation. Read More

Neurogastroenterol Motil 2022 Jan 20:e14319. Epub 2022 Jan 20.

Division of Gastroenterology and Digestive Diseases, University of California-San Diego Department of Medicine, San Diego, California, USA.

Background: It is debated whether high-resolution manometric (HRM) integrated relaxation pressure (IRP) or functional lumen imaging probe (FLIP) distensibility index (DI) is the superior measure of esophagogastric junction (EGJ) opening. We examined the relationship between the DI and IRP and assessed correlations with dysphagia symptoms in patients with achalasia and EGJ outflow obstruction (EGJOO).

Methods: Patients with achalasia and those with barium tablet retention at the EGJ were grouped as follows: Group 1:Achalasia (IRP ≥ 15 mmHg + complete absence of normal peristalsis); Group 2: Manometric +FLIP EGJOO (IRP ≥ 15 mmHg with some intact peristalsis + DI ≤ 2. Read More

VideoGIE 2022 Jan 22;7(1):1-20. Epub 2021 Oct 22.

Division of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.

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. Read More

Gastrointest Endosc 2022 05 1;95(5):855-863. Epub 2022 Jan 1.

Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, USA.

Background And Aims: Outcomes after peroral endoscopic myotomy (POEM) are assessed clinically by the Eckardt score (ES) or objectively by high-resolution manometry (HRM) and functional lumen imaging probe (FLIP). This study compared HRM and FLIP to evaluate clinical response after POEM.

Methods: This was a single tertiary center retrospective study of consecutive patients who underwent POEM for treatment-naive achalasia and with ≥6 months of follow-up. Read More

Asian J Surg 2022 Feb 17;45(2):725-726. Epub 2021 Dec 17.

Department of Ultrasound, The Central Hospital of Wuhan, Wuhan, 430000, Hubei, China. Electronic address:

Frontline Gastroenterol 2021 4;12(7):696-697. Epub 2021 Feb 4.

Gastroenterology department, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK.

Abdom Radiol (NY) 2022 02 17;47(2):538-546. Epub 2021 Dec 17.

Department of Biostatistics, Clinical Trial Center, Soonchunhyang University College of Medicine, Bucheon Hospital, 170 Jomaru-ro, Bucheon-Si, Gyeonggi-do, 14584, Republic of Korea.

Purpose: The purpose of our study was to evaluate the role of timed barium esophagogram (TBE) in quantitative measurement of improved esophageal emptying in primary achalasia patients treated with POEM. Also, we investigated the correlation of TBE with improvement of clinical symptoms as measured by Eckardt score.

Methods: This retrospective study included 30 patients who underwent POEM due to primary achalasia. Read More

Arq Gastroenterol 2021 Oct-Dec;58(4):491-494

Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.

Background: Dysphagia is the most frequent digestive symptom in Chagas disease, although other symptoms are reported. These symptoms can be associated with the degree of radiological impairment of the esophagus and the duration of dysphagia.

Objective: This investigation aimed to assess the symptoms and the time of dysphagia related to the different degrees of megaesophagus in patients with Chagas disease. Read More

Dis Esophagus 2022 Apr;35(4)

Department of Medicine, Division of Gastroenterology & Hepatology, University of Pennsylvania, Philadelphia, PA, USA.

Background: Esophagogastric junction outflow obstruction (EGJOO) has a variable disease course. Currently, barium swallow (BaS) and manometric parameters are used to characterize clinically significant EGJOO. The esophagogastric junction distensibility index (EGJ-DI) measured via functional lumen imaging probe (FLIP) can provide complementary information. Read More