FLIP Panometry as effective as high-resolution manometry for detecting hiatus hernia

A new study published in Neurogastroenterology and Motility Journal suggests that, although esophageal distension with functional luminal imaging probe (FLIP) testing seems to provoke and/or expand an hiatus hernia (HH) in an extra 25% of individuals, FLIP can identify HH with a considerable agreement with high-resolution manometry (HRM).

Probe for functional luminal imaging Panometry analyzes the biomechanics and motility of the esophagus reaction to distension. In FLIP experiments, we have shown that hiatus hernia is seen as a gap between the crural diaphragm (CD) and lower esophageal sphincter (LES), similar to what is seen with high-resolution manometry. To compare FLIP findings to those from endoscopy and HRM in the identification of HH, Dustin A. Carlson and colleagues carried out this investigation.

In all, 100 participants who completed FLIP while undergoing sedated endoscopy and HRM were included in the research. On FLIP and HRM, LES-CD separation was measured, with the presence of HH being indicated by LES-CD ≥1 cm. The kappa (κ) statistic was used to assess the level of agreement.

The key findings of this study were:

1. With a high degree of agreement between the trials (84% agreement; = 0.667), hiatal hernias were seen in 32% of patients on HRM and 44% of patients on FLIP.

2. On FLIP, there were 11 individuals with an "enlarged" HH (LES-CD 2 cm bigger than on HRM) and 14 patients with a "new" HH (HH not seen on HRM).

3. Patients with new or enlarged HH on FLIP experienced delayed esophageal emptying on timed barium esophagogram (TBE) more frequently than those without: 2/12 (17%) compared to 7/11 (64%); p = 0.017.

In conclusion, this study showed that when patients are being assessed for esophageal motility problems, esophageal distension testing using FLIP Panometry may help and perhaps improve the assessment of HH. Additionally, using a supplementary examination with HRM and FLIP Panometry may make it easier to identify clinically important subgroups of HH that may have an effect on mechanical obstruction or gastroesophageal reflux disease. In the end, more research is required to fully assess the unique discoveries described in this study and to define the clinical implications.

Reference:

Carlson, D. A., Kahrilas, P. J., Simlote, A., Vespa, E., Teitelbaum, E., Hungness, E., Kou, W., & Pandolfino, J. E. (2022). Identifying hiatal hernia with impedance planimetry during esophageal distension testing. In Neurogastroenterology & Motility. Wiley. https://doi.org/10.1111/nmo.14470