Utility of functional lumen imaging probe in esophageal measurements and dilations: a single pediatric center experience
Pediatric esophageal stenosis can be challenging to manage due to post-dilation tissue response involving fibroblast activity resulting in scar reformation. The functional lumen imaging probe (FLIP) uses high-resolution impedance planimetry to measure key luminal parameters during a volume-controlled distension. We sought to evaluate the safety as well as possible settings of EndoFLIP and EsoFLIP in the pediatric population.
We performed a retrospective chart review of all patients that had EndoFLIP (with and without balloon dilation) or EsoFLIP done between July 2017 and May 2018.
Eighteen patients were identified and 19 FLIP procedures were performed during esophagogastroduodenoscopy (10 EndoFLIP, 6 EndoFLIP + traditional balloon dilation, 3 EsoFLIP). Median age for the population was 13.7 years. Dysphagia was the most common chief complaint prior to endoscopic intervention. EndoFLIP measurements were most commonly taken at 20 ml and/or 30 ml of infusion. Diameter, compliance, cross-sectional area, and distensibility index were similar between infusion volumes. Median procedure time of the EndoFLIP + traditional balloon dilation group was longer (60.5 min) than the median procedure time of the EsoFLIP group (35 min, p = 0.12). Median fluoroscopy time of the EndoFLIP + traditional balloon dilation group was 0.6 min and the median fluoroscopy time of the EsoFLIP group was 0.5 min (p = 0.79). EndoFLIP + traditional balloon dilation was associated with a smaller diameter increase compared to EsoFLIP (2.2 mm vs. 4 mm; p = 0.09). There were no complications.
Functional lumen imaging probe (FLIP) can safely provide important luminal measurements in pediatric patients with esophageal stenosis, and may guide therapy. Esophageal dilation using EsoFLIP may yield a larger diameter change and may potentially reduce procedure time when compared to traditional balloon dilation. Pediatric patients with epidermolysis bullosa and esophageal stenosis responded well to EsoFLIP dilation.
KeywordsFLIP EndoFLIP EsoFLIP Pediatrics Esophageal stenosis Esophageal dilation
Controlled radial expansion
Functional lumen imaging probe
Lower esophageal sphincter
KN was the primary author of the manuscript including creation of the tables and figure. DM helped edit the manuscript, figure, and tables, providing valuable feedback to help shape the work. JH helped edit the manuscript, figure, and tables, providing valuable feedback. MK oversaw the project and also helped edit the manuscript, figure, and tables.
Compliance with ethical standards
Dr. Kenneth Ng is a consultant for Medtronic. Dr. Mouen Khashab is a consultant for Olympus, Boston Scientific, and Medtronic. Drs. Douglas Mogul and John Hollier have no conflicts of interest or financial ties to disclose.
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