Normative values for esophageal functional lumen imaging probe measurements: A meta‐analysis

• Published in: Neurogastroenterology and motility Vol. 34; no. 11; pp. e14419 - n/a
• Main Authors: Bredenoord, Albert J., Rancati, Francesca, Lin, Haiying, Schwartz, Naama, Argov, Mirit
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.11.2022; John Wiley and Sons Inc
• Subjects: achalasia; Adult; catheter; Clinical medicine; Clinical Review; Diagnostic Imaging; dysphagia; Esophageal Achalasia; Esophagogastric Junction - diagnostic imaging; Esophagus; Healthy Volunteers; Humans; manometry; Manometry - methods; Meta-analysis; reflux disease; dysphagia; catheter; manometry; reflux disease; achalasia; esophagus
• ISSN: 1350-1925; 1365-2982; 1365-2982
• DOI: 10.1111/nmo.14419

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. A meta‐analysis of clinical studies describing Endoflip™ use for measurements of esophagogastric junction distensibility index (EGJ‐DI) in healthy subjects reveals that only 5.4% of subjects have an EGJ‐DI of 2 mm2/mmHg or lower, values below it can be considered abnormal. The clinical use of an upper limit for normality of EGJ‐DI seems questionable.