Utility of functional lumen imaging probe in esophageal measurements and dilations: a single pediatric center experience.

Abstract

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 13.7years. Dysphagia was the most common chief complaint prior to endoscopic intervention. EndoFLIP measurements were most commonly taken at 20ml and/or 30ml 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 (60.5min) than the median procedure time of the EsoFLIP group (35min, p = 0.12). Median fluoroscopy time of the EndoFLIP + traditional balloon dilation group was 0.6min and the median fluoroscopy time of the EsoFLIP group was 0.5min (p = 0.79). EndoFLIP + traditional balloon dilation was associated with a smaller diameter increase compared to EsoFLIP (2.2mm vs. 4mm; 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.