A Combined Endoscopy and Functional Lumen Imaging Probe Panometry Approach Can Expedite Diagnosis of Esophageal Motility Disorders.

Objective: Upper endoscopy and functional lumen imaging probe (FLIP) Panometry offer a complementary approach to diagnose esophageal motility disorders during the sedated endoscopy encounter. This study aimed to evaluate an approach combining an endoscopic motility score (CARS) and FLIP Panometry to diagnosis esophageal motility disorders.

Methods: Adult patients who completed upper endoscopy with FLIP and high-resolution manometry (HRM) were included. Endoscopic videos were reviewed to determine the CARS score. Esophagogastric junction (EGJ) opening and contractility profile were applied to derive a FLIP Panometry motility classification. HRM and Chicago Classification version 4.0 (CCv4.0) were utilized as the reference standard.

Results: 224 patients (mean (SD) age 52(18) years; 51% female) were included; 112 50%) had achalasia or conclusive EGJ outflow obstruction (EGJOO) per HRM/CCv4.0. Zero of 63 patients with CARS score 0-1 and normal EGJ opening on FLIP Panometry had achalasia/conclusive EGJOO (100% negative predictive value). 65/65 patients with CARS score ≥4 and FLIP Panometry classifications of non-spastic obstruction (n=65) had achalasia/conclusive EGJOO, which was non-spastic in 63 (97% positive predictive value). Of the remaining 96/224 (43%) patients with other CARS-FLIP combinations, 47 (49%) patients had achalasia/conclusive EGJOO.

Conclusions: An approach utilizing endoscopy (CARS score) and FLIP Panometry (EndoMAP) identified actionable esophageal motility disorders at the point-of-care endoscopy encounter. While additional validation is planned, this approach offers a well-tolerated method that addresses limitations of HRM. Applied to the index endoscopic encounter, this approach could expedite management, reducing need for HRM in some patients versus triaging toward additional testing in others.