Functional lumen imaging probe use in a high-volume practice: Practical and technical implications

doi:10.4253/wjge.v16.i7.396

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World Journal of Gastrointestinal Endoscopy

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1948-5190

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastrointest Endosc. Jul 16, 2024; 16(7): 396-405
Published online Jul 16, 2024. doi: 10.4253/wjge.v16.i7.396

Table 1 Functional lumen imaging probe patient and procedure details, n (%)/mean ± SD

Characteristics	Patient details (n = 398)
Age (years)	55.1 ± 16.3
Sex
Male	148 (37.2)
Female	250 (62.8)
Race
White	240 (60.3)
Black	14 (3.5)
Hispanic	40 (10.1)
Asian	47 (11.8)
Other	49 (12.3)
Unknown	8 (2.0)
Opioid use	65 (16.3)
Prior foregut surgery	132 (33.2)
Anesthesia use	209 (52.5)
Moderate sedation	189 (47.5)
Midazolam dose (median) (mg)	5
Fentanyl dose (median) (mcg)	125
Procedure time (minutes)^a	21.4 ± 8.8
Moderate sedation	17.0 ± 6.3
Major complications¹	0

¹3 post procedure visits to emergency department (1 with nausea with scant hematemesis, 2 with pain)–complications ruled out.

^aP < 0.01, indicates a statistically significant difference after adjusting for procedure indication, balloon type and age.

Table 2 Characteristics of functional lumen imaging probe procedures by sedation type, n (%)/mean ± SD

	Anesthesia 196 (51.4)	Moderate sedation 185 (48.6)
		Midazolam dose (median), 5 mg
		Fentanyl dose (median), 125 mcg
Patient age	56.6 ± 16.5	54.0 ± 16.0
Sex
Male	64 (32.7)	77 (41.6)
Female	132 (67.3)	108 (58.4)
Race
White	124 (63.3)	106 (57.3)
Black	5 (2.6)	9 (4.9)
Hispanic	22 (11.2)	16 (8.7)
Asian	20 (10.2)	25 (13.5)
Other	21 (10.7)	25 (13.5)
Unknown	4 (2.0)	4 (2.2)
Procedure indication^a
Abnormal imaging	5 (2.6)	2 (1.1)
Abnormal manometry	31 (15.8)	36 (19.5)
Achalasia	26 (13.3)	14 (7.6)
Achalasia post therapy	29 (14.8)	28 (15.1)
Dysphagia	63 (32.1)	54 (29.2)
EoE	7 (3.6)	20 (10.8)
GERD	29 (14.8)	31 (16.8)
Other	6 (3.1)	0 (0)
Patient opioid use^a	46 (23.5)	17 (9.2)
Prior foregut surgery	73 (37.2)	53 (28.7)
Procedure time (mean min)^a	21.4 ± 8.8	17.0 ± 6.4
Procedure type^a
EndoFLIP	175 (89.3)	184 (99.5)
EsoFLIP	21 (10.7)	1 (0.05)

^aP < 0.01, indicates a statistically significant difference between two groups.

EoE: Eosinophilic esophagitis; GERD: Gastroesophageal reflux disease.

Table 3 Functional lumen imaging probe parameters at various distention volumes by sedation type, n (%)/mean ± SD

Measurement at distention volume	Anesthesia	Moderate sedation
DI (mm²/mmHg)
30	2.3 ± 2.0	2.1 ± 1.5
40	2.6 ± 2.2	2.5 ± 2.0
50	3.2 ± 2.4	3.0 ± 2.2
60	4.0 ± 2.9	3.6 ± 2.3
70	4.2 ± 2.4	3.9 ± 2.1
Diameter (mm)
30	6.8 ± 2.4	6.9 ± 2.0
40	8.1 ± 3.1	8.4 ± 3.0
50	10.2 ± 4.1	10.7 ± 3.8
60^a	11.5 ± 3.3	12.3 ± 3.4
70	14.6 ± 3.3	15.1 ± 3.6
Motility
RAC¹	65 (42.5)	88 (57.5)
IAC	10 (6.8)	9 (6.4)
RC	19 (12.9)	16 (11.4)
Absent²	63 (42.9)	38 (27.0)

¹Odds ratio (OR) = 0.4 (95%CI: 0.3-0.8) for having recurrent antegrade contracts (adjusted for procedure indication, patient opioid use and balloon used).

²OR = 2.4 (95%CI: 1.3-4.4) for having absent motility (adjusted for procedure indication, patient opioid use and balloon used).

^aP = 0.05, indicates a statistically significant difference between groups (adjusted for indication and patient opioid use).

DI: Distensibility index; RAC: Recurrent antegrade contracts: IAC: Isolated antegrade contractions: RC: Retrograde contractions.

Table 4 Patient and functional lumen imaging probe procedure details by balloon type, n (%)/mean ± SD

Balloon	EF-322 (n = 254, 70.4%)	EF-325 (n = 107, 29.6%)
Procedure date^a
9/2017-9/2018	10 (3.9)	58 (54.2)
10/2017-10/2018	97 (38.2)	39 (36.5)
11/2018-11/2019	147 (57.9)	10 (9.4)
Patient details
Age	54.7 ± 16.0	56.0 ± 16.9
Sex
Male	92 (36.2)	41 (38.3)
Female	162 (63.8)	66 (61.7)
Race
White	144 (56.7)	73 (68.2)
Black	10 (3.9)	4 (3.7)
Hispanic	28 (11.0)	8 (7.5)
Asian	35 (13.8)	7 (6.5)
Other	31 (12.2)	13 (12.2)
Unknown	6 (2.4)	2 (1.9)
Indication^a
Abnormal imaging	6 (2.4)	1 (0.9)
Abnormal manometry	38 (15.0)	29 (27.1)
Achalasia pre therapy	17 (6.7)	10 (9.4)
Achalasia post therapy	26 (10.2)	25 (23.4)
Dysphagia	86 (33.9)	30 (28.0)
EoE	22 (8.7)	5 (4.7)
GERD	53 (20.9)	7 (6.5)
Other	6 (2.4)	0 (0)
Opioid use	43 (16.9)	18 (16.8)
Prior foregut surgery^a	67 (26.4)	53 (49.5)
Procedure details
Anesthesia use	127 (50)	49 (45.8)
Moderate sedation	127 (50)	58 (54.2)
Midazolam dose (mg), (median)	5	6
Fentanyl dose (mcg), (median)	125	125
Procedure time (minute)
Anesthesia	22.3 ± 7.6	22.0 ± 11.4
Moderate sedation	17.5 ± 5.7	15.9 ± 7.6

^aP < 0.01, indicates a statistically significant difference group.

EoE: Eosinophilic esophagitis; GERD: Gastroesophageal reflux disease.

Table 5 Mean values of distensibility index, diameter and cross sectional area by distention volume, mean ± SD

Distention volume (mL)	Balloon used
Distention volume (mL)	EF-322	EF-325
DI (mm²/mmHg)
30	1.93 ± 1.18^a	2.66 ± 2.24
40	2.32 ± 1.65^a	3.17 ± 2.83^b
50	3.05 ± 2.27^a	3.27 ± 2.41^b
60	3.79 ± 2.58^a
70	4.03 ± 2.25^a
Diameter (mm)^c
30	6.07 ± 1.62	8.01 ± 2.51
40	7.23 ± 2.42	10.58 ± 3.15
50	9.29 ± 3.20	13.53 ± 4.13
60	11.92 ± 3.36
70	14.84 ± 3.45
CSA (mm²)^c
30	30.97 ± 18.24	55.26 ± 35.13
40	45.71 ± 30.82	95.57 ± 53.83
50	75.78 ± 48.13	157.19 ± 86.11
60	120.18 ± 61.24
70	182.75 ± 75.45

^aP < 0.02, indicates within balloon group differences significant in EF-322.

^bP = 0.55, indicates in EF-325 not different at 40 and 50 mL.

^cP < 0.01, indicates within balloon group differences significant in both groups.

DI: Distensibility index; CSA: Cross sectional area.

Citation: Jiang Y, Vazquez-Reyes R, Kamal A, Zikos T, Triadafilopoulos G, Clarke JO. Functional lumen imaging probe use in a high-volume practice: Practical and technical implications. World J Gastrointest Endosc 2024; 16(7): 396-405
URL: https://www.wjgnet.com/1948-5190/full/v16/i7/396.htm
DOI: https://dx.doi.org/10.4253/wjge.v16.i7.396