TY - JOUR
T1 - Normative values for esophageal functional lumen imaging probe measurements
T2 - A meta-analysis
AU - Bredenoord, Albert J.
AU - Rancati, Francesca
AU - Lin, Haiying
AU - Schwartz, Naama
AU - Argov, Mirit
N1 - Funding Information: Early article review was completed by Hila Cohen (H.C.). Biostatistical support was provided by Zengri Wang, PhD of Medtronic (Minneapolis, MN). Medical writing support was provided by Hanan Zavala, PhD of Medtronic (Minneapolis, MN) in accordance with Good Publication Practice (GPP3) guidelines.33 Funding Information: The research project was sponsored by Medtronic, which contributed to the project design, data collection and analysis, and manuscript writing. The lead author had full access to all data and final responsibility for the decision to submit for publication. The author was not paid to write this article by the sponsor or any other agency. Funding Information: AJB received research funding from Nutricia, Bayer, Norgine, SST and Thelial and received speaker and/or consulting fees from AstraZeneca, Alimentiv, Thelial, Medtronic, Laborie, Regeneron, Sanofi, DrFalkPharma, Reckitt Benckiser, Arena, Calypso. Publisher Copyright: © 2022 The Authors. Neurogastroenterology & Motility published by John Wiley & Sons Ltd.
PY - 2022/11
Y1 - 2022/11
N2 - 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. Meta-analysis was performed based on published values. Results: A total of 17 articles were included in the systematic review, 15 of which were included in the meta-analysis, representing 154 unique subjects. At 40 ml distention, the 5th–95th and 10th–90th percentiles for esophagogastric junction distensibility index (EGJ-DI) were 1.96–10.95 mm2/mmHg and 2.36–8.95 mm2/mmHg, respectively. An EGJ-DI below 2 mm2/mmHg was found in 5.4%, and below 3 mm2/mmHg in 20.1% of healthy subjects. At 50 ml distention, the 5th–95th and 10th–90th percentiles for EGJ-DI are 2.86–10.66 mm2/mmHg and 3.28–9.12 mm2/mmHg, respectively (below 2 mm2/mmHg: 0.6%, 3 mm2/mmHg: 6.3%). The 5th–95th and 10th–90th percentiles for EGJ-DI at 60 ml distention were 3.06–8.14 mm2/mmHg and 3.33–7.18 mm2/mmHg, respectively (below 2 mm2/mmHg: 0.0%, 3 mm2/mmHg: 7%). A clear cut-off for lower values was identified while a large spread in values was observed for upper limits of normal for EGJ-DI for all filling volumes. Conclusions: Given these observations, we recommend using a cut-off of 2 mm2/mmHg for clinical practice, values below can be considered abnormal. Given that 5.4% of the healthy subjects will have an EGJ-DI below 2 mm2/mmHg at 40 ml, we recommend using the 50 and 60 ml distention volumes. The clinical use of an upper limit for normality of EGJ-DI seems questionable.
AB - 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. Meta-analysis was performed based on published values. Results: A total of 17 articles were included in the systematic review, 15 of which were included in the meta-analysis, representing 154 unique subjects. At 40 ml distention, the 5th–95th and 10th–90th percentiles for esophagogastric junction distensibility index (EGJ-DI) were 1.96–10.95 mm2/mmHg and 2.36–8.95 mm2/mmHg, respectively. An EGJ-DI below 2 mm2/mmHg was found in 5.4%, and below 3 mm2/mmHg in 20.1% of healthy subjects. At 50 ml distention, the 5th–95th and 10th–90th percentiles for EGJ-DI are 2.86–10.66 mm2/mmHg and 3.28–9.12 mm2/mmHg, respectively (below 2 mm2/mmHg: 0.6%, 3 mm2/mmHg: 6.3%). The 5th–95th and 10th–90th percentiles for EGJ-DI at 60 ml distention were 3.06–8.14 mm2/mmHg and 3.33–7.18 mm2/mmHg, respectively (below 2 mm2/mmHg: 0.0%, 3 mm2/mmHg: 7%). A clear cut-off for lower values was identified while a large spread in values was observed for upper limits of normal for EGJ-DI for all filling volumes. Conclusions: Given these observations, we recommend using a cut-off of 2 mm2/mmHg for clinical practice, values below can be considered abnormal. Given that 5.4% of the healthy subjects will have an EGJ-DI below 2 mm2/mmHg at 40 ml, we recommend using the 50 and 60 ml distention volumes. The clinical use of an upper limit for normality of EGJ-DI seems questionable.
KW - achalasia
KW - catheter
KW - dysphagia
KW - esophagus
KW - manometry
KW - reflux disease
UR - http://www.scopus.com/inward/record.url?scp=85131180992&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/nmo.14419
DO - https://doi.org/10.1111/nmo.14419
M3 - Review article
C2 - 35665566
SN - 1350-1925
VL - 34
JO - Neurogastroenterology and Motility
JF - Neurogastroenterology and Motility
IS - 11
M1 - e14419
ER -