Search Our Scientific Publications & Authors

J Immunother 2021 Jun 23. Epub 2021 Jun 23.

Dermatology Department Neurology Department Gastroenterology Department, CHU de Bordeaux University of Bordeaux, Inserm U-1035 Dermatology Department, CH La Rochelle, Bordeaux, France.

Immunotherapy with immune checkpoint inhibitors (ICIs) has improved the prognosis of many cancers; a combination of nivolumab (anti-programmed cell death protein 1) and ipilimumab (anti-cytotoxic T-lymphocyte-associated protein 4) is approved as first-line therapy for advanced melanoma, with objective responses obtained in more than half of patients. However, this combination is associated with a high rate of immune-related adverse events, which are often severe and multiple. Neurological immune-related adverse events are rare but feared because they can be life-threatening, their diagnosis and management are challenging, and patients can have irreversible sequelae. Read More

Zentralbl Chir 2021 Jun 21. Epub 2021 Jun 21.

Klinik für Allgemein- und Viszeralchirurgie, Kliniken Maria Hilf GmbH, Mönchengladbach, Deutschland.

Background: Achalasia refers to a primary oesophageal motility disorder characterised by the absence of peristalsis and incomplete or complete lack of relaxation of the lower oesophageal sphincter. The cardinal symptom is dysphagia. The therapeutic goal is surgical or interventional repair of the oesophageal outflow tract at the level of the oesophagogastric junction. Read More

Neurogastroenterol Motil 2021 Jun 13:e14192. Epub 2021 Jun 13.

Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.

Background And Aims: This study aimed to systematically evaluate a classification scheme of secondary peristalsis using functional luminal imaging probe (FLIP) panometry through comparison with primary peristalsis on high-resolution manometry (HRM).

Methods: 706 adult patients that completed FLIP and HRM for primary esophageal motility evaluation and 35 asymptomatic volunteers ("controls") were included. Secondary peristalsis, that is, contractile responses (CRs), was classified on FLIP panometry by the presence and pattern of contractility as normal (NCR), borderline (BCR), impaired/disordered (IDCR), absent (ACR), or spastic-reactive (SRCR). Read More

Medicine (Baltimore) 2021 Jun;100(23):e26248

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

Abstract: Peroral endoscopic myotomy (POEM) is an endoscopic alternative to surgical myotomy in patients with achalasia. This study aimed to evaluate the efficacy and clinical outcomes of POEM.A total of 20 patients with achalasia who underwent POEM between October 2016 and November 2017 were prospectively recruited. Read More

Dig Liver Dis 2021 May 11. Epub 2021 May 11.

Università degli Studi di Milano, Milan, Italy; UOC Gastroenterologia ed Endoscopia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F Sforza, 35, Milan, Italy. Electronic address:

High resolution manometry (HRM), developed from conventional manometry, is the gold standard for assessment of esophageal motor function worldwide. The Chicago Classification, now in its fourth iteration, is the modern standard for HRM categorization of esophageal motility disorders. The HRM protocol has expanded from the original 10 supine swallow standard, to include upright swallows, and provocative maneuvers such as multiple rapid swallows, rapid drink challenge and standardized test meal. Read More

Surg Endosc 2021 May 4. Epub 2021 May 4.

Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, 6550 Fannin Street, Suite 1661, Houston, TX, 77030, USA.

Background: Manometry is the gold standard diagnostic test for achalasia. However, there are incidences where manometry cannot be obtained preoperatively, or the results of manometry is inconsistent with the patient's symptomatology. We aim to determine if intraoperative use of EndoFLIP can provide a diagnosis of achalasia and provide objective information during Heller myotomy and Dor fundoplication. Read More

Ann Surg 2021 Jun;273(6):1135-1140

Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.

Objective: We aim to describe the long-term follow-up data from our institution's POEM experience.

Summary Background Data: Per-oral endoscopic myotomy (POEM) is a well-established endoscopic therapy for achalasia with excellent short-term efficacy, but long-term outcomes data are limited.

Methods: Patients older than 4 years removed from POEM for treatment of achalasia were studied. Read More

VideoGIE 2021 Apr 12;6(4):167-169. Epub 2021 Feb 12.

University of California, San Diego, La Jolla, California.

Neurogastroenterol Motil 2021 Apr 19:e14133. Epub 2021 Apr 19.

Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA.

Background: Achalasia is an esophageal motility disorder characterized by esophagogastric junction (EGJ) dysfunction and impaired esophageal peristalsis with significant impact on quality of life. While the functional luminal imaging probe (FLIP) has been used to assess EGJ distensibility in achalasia, its clinical utility in pediatrics is limited due to absence of normative values and correlations with clinical outcomes in children. Thus, we sought to evaluate FLIP's use in a pediatric achalasia cohort undergoing dilations and non-achalasia controls. Read More

Neurogastroenterol Motil 2021 Mar 26:e14134. Epub 2021 Mar 26.

Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Esophageal hypomotility disorders manifest with abnormal esophageal body contraction vigor, breaks in peristaltic integrity, or failure of peristalsis in the context of normal lower esophageal sphincter relaxation on esophageal high-resolution manometry (HRM). The Chicago Classification version 4.0 recognizes two hypomotility disorders, ineffective esophageal motility (IEM) and absent contractility, while fragmented peristalsis has been incorporated into the IEM definition. Read More

Can J Anaesth 2021 07 9;68(7):1077-1079. Epub 2021 Mar 9.

Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada.

Neurogastroenterol Motil 2021 Mar 11:e14116. Epub 2021 Mar 11.

Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.

Background: Functional luminal imaging probe (FLIP) Panometry assesses the esophageal response to distention and may complement the assessment of primary peristalsis on high-resolution manometry (HRM). We aimed to investigate whether FLIP Panometry provides complementary information in patients with normal esophageal motility on HRM.

Methods: Adult patients that completed FLIP and had an HRM classification of normal motility were retrospectively identified for inclusion. Read More

Gastrointest Endosc 2021 Mar 1. Epub 2021 Mar 1.

Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.

Background And Aims: The functional luminal imaging probe (FLIP) is a novel catheter-based device that measures esophagogastric junction (EGJ) distensibility index (DI) in real time. Previous studies have demonstrated DI to be a predictor of post-treatment clinical outcomes in patients with achalasia. We sought to evaluate EGJ DI in patients with achalasia before, during, and after peroral endoscopic myotomy (POEM) and laparoscopic Heller myotomy (LHM) and to assess the correlation of DI with postoperative outcomes. Read More

Am J Physiol Gastrointest Liver Physiol 2021 May 3;320(5):G780-G790. Epub 2021 Mar 3.

Department of Mechanical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois.

In this study, we quantify the work done by the esophagus to open the esophagogastric junction (EGJ) and create a passage for bolus flow into the stomach. Work done on the EGJ was computed using functional lumen imaging probe (FLIP) panometry. Eighty-five individuals underwent FLIP panometry with a 16-cm catheter during sedated endoscopy including asymptomatic controls ( = 14), 45 patients with achalasia ( = 15 each, three subtypes), those with gastroesophageal reflux disease (GERD; = 13), those with eosinophilic esophagitis (EoE; = 8), and those with systemic sclerosis (SSc; = 5). Read More

Biomech Model Mechanobiol 2021 Jun 2;20(3):925-940. Epub 2021 Mar 2.

Theoretical and Applied Mechanics, Northwestern University, 2145 Sheridan Road, Evanston, IL, 60208, USA.

Fluoroscopy is a radiographic procedure for evaluating esophageal disorders such as achalasia, dysphasia and gastroesophageal reflux disease. It performs dynamic imaging of the swallowing process and provides anatomical detail and a qualitative idea of how well swallowed fluid is transported through the esophagus. In this work, we present a method called mechanics informed fluoroscopy (FluoroMech) that derives patient-specific quantitative information about esophageal function. Read More

Korean J Gastroenterol 2021 02;77(2):71-76

Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Patients with esophageal dysphagia need a step-by-step approach for diagnosis and treatment. Endoscopic with biopsy and barium esophagogram are the essential tests evaluating anatomical abnormality and esophageal bolus stasis. Further imaging or esophageal function tests such as high-resolution esophageal manometry, functional endoluminal imaging probe, CT or endoscopic ultrasound are required. Read More

Korean J Gastroenterol 2021 02;77(2):64-70

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

Esophageal motility disorders were re-defined when high-resolution manometry was employed to better understand their pathogenesis. Newly developed parameters including integrated relaxation pressure (IRP), distal contractile integral, and distal latency showed better diagnostic yield compared with previously used conventional parameters. Therefore, Chicago classification was formulated, and its diagnostic cascade begins by assessing the IRP value. Read More

Am Fam Physician 2021 01;103(2):97-106

Mayo Clinic College of Medicine and Science, Rochester, MN, USA.

Dysphagia is common but may be underreported. Specific symptoms, rather than their perceived location, should guide the initial evaluation and imaging. Obstructive symptoms that seem to originate in the throat or neck may actually be caused by distal esophageal lesions. Read More

Neurogastroenterol Motil 2021 01;33(1):e14058

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

Chicago Classification v4.0 (CCv4.0) is the updated classification scheme for esophageal motility disorders using metrics from high-resolution manometry (HRM). Read More

Gastrointest Endosc 2021 01;93(1):107-109

Division of Digestive Diseases, Department of Pathology, Emory University School of Medicine, Atlanta, Georgia, USA.

J Clin Gastroenterol 2021 Feb;55(2):e8-e18

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

The esophagogastric junction (EGJ) is a complex barrier between the thoracic and abdominal luminal gut compartments, comprised primarily of the lower esophageal sphincter (LES) and crural diaphragm. Although closed at rest, the EGJ relaxes to allow antegrade bolus transit and retrograde venting of air. Abnormal relaxation is the hallmark of achalasia spectrum disorders, while increased frequency of transient lower esophageal sphincter relaxations and/or EGJ disruption are seen in gastroesophageal reflux disease. Read More

Cancer Invest 2021 Feb 6;39(2):159-162. Epub 2021 Jan 6.

Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA.

Neurological paraneoplastic syndromes are exceedingly rare, and often difficult to recognize clinically. Paraneoplastic achalasia is a condition characterized by new-onset dysphagia that is unrelated to tumor burden, most often due to the development of auto-immune antibodies targeting esophageal tissue. Due to the rarity of this condition, diagnosis is often delayed, leading to increased time to treatment. Read More

Therap Adv Gastroenterol 2020 24;13:1756284820969050. Epub 2020 Oct 24.

Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.

Background: This study aimed to introduce a novel analysis paradigm, referred to as 4-dimensional (4D) manometry based on biophysical analysis; 4D manometry enables the visualization of luminal geometry of the esophagus and esophagogastric junction (EGJ) using high-resolution-impedance-manometry (HRIM) data.

Methods: HRIM studies from two asymptomatic controls and one type-I achalasia patient were analyzed. Concomitant fluoroscopy images from one control subject were used to validate the calculated temporal-spatial luminal radius and time-history of intraluminal bolus volume and movement. Read More

Am J Physiol Gastrointest Liver Physiol 2021 02 11;320(2):G217-G226. Epub 2020 Nov 11.

Department of Mechanical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois.

The goal of this study was to conceptualize and compute measures of "mechanical work" done by the esophagus using data generated during functional lumen imaging probe (FLIP) panometry and compare work done during secondary peristalsis among patients and controls. Eighty-five individuals were evaluated with a 16-cm FLIP during sedated endoscopy, including asymptomatic controls ( = 14) and those with achalasia subtypes I, II, and III ( = 15, each); gastroesophageal reflux disease (GERD; = 13); eosinophilic esophagitis (EoE; = 9); and systemic sclerosis (SSc; = 5). The FLIP catheter was positioned to have its distal segment straddling the esophagogastric junction (EGJ) during stepwise distension. Read More

Am J Gastroenterol 2020 11;115(11):1786-1796

Washington University, St. Louis, St. Louis, Missouri, USA.

The functional lumen imaging probe (FLIP) measures luminal dimensions using impedance planimetry, performed most often during sedated upper endoscopy. Mechanical properties of the esophageal wall and opening dynamics of the esophagogastric junction (EGJ) can be objectively evaluated in esophageal motor disorders, eosinophilic esophagitis, esophageal strictures, during esophageal surgery and in postsurgical symptomatic states. Distensibility index, the ratio of EGJ cross sectional area to intraballoon pressure, is the most useful FLIP metric. Read More

Am J Gastroenterol 2021 02;116(2):407-410

Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.

Introduction: Per-oral endoscopic myotomy (POEM) is an effective modality for the management of achalasia. Tension pneumoperitoneum is a significant complication that causes hemodynamic instability, generally within the periprocedural period.

Methods: Here, we report 2 cases of delayed tension pneumoperitoneum that was recognized and treated several hours after uncomplicated POEM. Read More

World J Gastroenterol 2020 Oct;26(38):5863-5873

Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China.

Background: People with achalasia typically have a thick lower esophageal muscularis propria (LEMP), and peroral endoscopic myotomy (POEM) has been effective in treating most patients. LEMP thickness may be associated with the outcomes and prognosis after POEM. However, more evidence is needed regarding the relationship between LEMP thickness and patient prognosis after POEM. Read More

Neurol India 2020 Sep-Oct;68(5):1253-1254

Department of Pediatrics, CHILDS Trust Medical Research Foundation, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu, India.

Int J Surg Case Rep 2020 7;76:324-327. Epub 2020 Oct 7.

University of the West Indies, Department of Clinical Surgical Sciences, Trinidad and Tobago; Medical Associates, St. Joseph, Trinidad and Tobago.

Introduction: Achalasia is an uncommon oesophageal motility disorder caused by failed relaxation of a hypertensive lower oesophageal sphincter in response to swallowing. It often manifests clinically with symptoms such as dysphagia, regurgitation, and weight loss. Manometry is considered the gold standard diagnostic test in diagnosing this condition. Read More

Eur J Radiol 2020 Nov 12;132:109265. Epub 2020 Sep 12.

Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Germany.

Purpose: To investigate imaging findings of esophageal motility disorders on dynamic real-time.

Material And Methods: 102 patients with GERD-like symptoms were included in this retrospective study between 2015-2018. Dynamic real-time MRI visualized the transit of a 10 mL pineapple juice bolus through the esophagus and EGJ with a temporal resolution of 40 ms. Read More