Work

FLIP Measurements Predict Short‐Term Outcomes After Singular EsoFLIP Dilation in Patients With Achalasia

Year: 2026

Type: article

Abstract: ABSTRACT Background FLIP enables real‐time measurement of esophagogastric junction (EGJ) dimensions and pressures during dilation. While FLIP metrics predict outcomes after pneumatic dilation, POEM, and myotomy, their predictive value following EsoFLIP dilation remains unknown. This study identified FLIP measurements predicting short‐term outcomes after EsoFLIP dilation in patients with achalasia. Methods Treatment‐naïve patients undergoing singular EsoFLIP dilation (2017–2025) were analyzed. EGJ diameter (EGJ‐Dia) and cross‐sectional area (EGJ‐CSA) were measured at 70 mL, distensibility index (EGJ‐DI) and balloon pressure (EGJ‐BP) at 60 mL, pre‐ and post‐dilation. Primary outcome was excellent short‐term symptomatic response at 4 weeks (Eckardt score ≤ 1). Results Seventy‐nine patients (38% female, median age 52 years, achalasia type 1: 8%, type 2: 87%, type 3: 5%) were included. Symptomatic response was 81% (ES ≤ 3 or Δ ≥ 3) and 46% (ES ≤ 1); objective response 67%. Median ES decreased from 6 (IQR 4–7) to 2 (IQR 0–4). Median EGJ‐Dia increased from 10 mm to 17 mm, EGJ‐CSA from 72 mm 2 to 220 mm 2 , and EGJ‐DI from 1.4 mm 2 /mmHg to 5.8 mm 2 /mmHg, while EGJ‐BP decreased from 31 mmHg to 24 mmHg (all p < 0.001). Among 51 patients with complete data, ΔEGJ‐Dia70 (AUROC 0.77, cut‐off ≥ 6.3 mm) and ΔEGJ‐CSA70 (AUROC 0.75, cut‐off ≥ 129.3 mm 2 ) showed highest predictive performance. ΔEGJ‐DI60 showed moderate performance (AUROC 0.65), while ΔBP60 was non‐discriminative (AUROC 0.45). Conclusion Delta values in FLIP metrics, particularly ΔEGJ‐Dia and ΔEGJ‐CSA, predicted excellent short‐term symptomatic response. These findings indicate that intra‐procedural FLIP panometry may help assess treatment adequacy during EsoFLIP dilation.

Source: Neurogastroenterology & Motility

DOI: 10.1111/nmo.70500

Authors: Johann Stuby, Valeria Schindler, Joel Schnellmann, Jessica Martinez, Amanda Bianca, Daniel Pohl

Institutions: University Hospital Zurich, Triemli Hospital

Language: English

Topic: Gastroesophageal reflux and treatments

Subfield: Gastroenterology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,640