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

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

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	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 indicationa
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 usea	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 typea
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
60a	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 datea
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)
Indicationa
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 surgerya	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
	EF-322	EF-325
DI (mm2/mmHg)
30	1.93 ± 1.18a	2.66 ± 2.24
40	2.32 ± 1.65a	3.17 ± 2.83b
50	3.05 ± 2.27a	3.27 ± 2.41b
60	3.79 ± 2.58a
70	4.03 ± 2.25a
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.