Abstract
Impedance planimetry is an imaging technique that provides in vivo esophageal distensibility data in real time. A catheter equipped with a cylindrical bag is gradually distended with a conductive solution. Impedance and intrabag pressure readings are used to calculate the distensibility index as ratio of the cross-sectional area at the narrowest spot to intrabag pressure. In healthy volunteers esophagogastric junction distensibility, obtained at 40 mL bag filling volume, shows a wide variation of 2.7–7.1 mm2/mmHg. In achalasia patients distensibility is significantly lower (≤1.6 mm2/mmHg) and normalizes after successful treatment. Post-interventional distensibility index values in the range of 4.5–8.5 mm2/mmHg predict good outcome. Impedance planimetry imaging has recently been integrated into a dilatation catheter for treatment of achalasia and a feasibility study reported technical success in all therapeutic interventions using this device. In patients affected by eosinophilic esophagitis distensibility of the esophagogastric junction is lower than in healthy controls and in the tubular esophagus a distension plateau is reached at a narrower luminal diameter, reflecting the remodeling of the esophageal wall in this disease. In patients with small hiatal hernias impedance planimetry is able to display the lower esophageal sphincter and the crural diaphragm as spatially separated regions of reduced distensibility. Each component is more distensible than the single esophagogastric junction in subjects without hiatal hernia. Conflicting data exist regarding esophagogastric junction distensibility in patients with gastroesophageal reflux disease. Two studies found higher and one reported lower values compared to asymptomatic controls. Intra- and postoperative impedance planimetry studies showed that laparoscopic antireflux surgery results in a significant reduction of esophagogastric junction distensibility, being significantly more pronounced after a Nissen than a Toupet fundoplication. Impedance planimetry is the only diagnostic tool available in clinical routine to examine mechanical wall properties in vivo. It complements other diagnostic procedures like endoscopy, videofluoroscopy, and high-resolution (impedance) manometry in the assessment of esophageal function in various disease states and has become a valuable tool for monitoring and tailoring therapeutic interventions.
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Abbreviations
- CSA:
-
Cross-sectional area
- DI:
-
Distensibility index,
- EGJ:
-
Esophagogastric junction
- EoE:
-
Eosinophilic esophagitis,
- FLIP:
-
Functional lumen imaging probe
- LES:
-
Lower esophageal sphincter
- POEM:
-
Peroral endoscopic myotomy
References
Carlson DA, Kahrilas PJ, Lin Z, Hirano I, Gonsalves N, Listernick Z, Ritter K, Tye M, Ponds FA, Wong I, Pandolfino JE (2016) Evaluation of esophageal motility utilizing the functional lumen imaging probe. Am J Gastroenterol 111(12):1726–1735. https://doi.org/10.1038/ajg.2016.454
Chen JW, Pandolfino JE, Lin Z, Ciolino JD, Gonsalves N, Kahrilas PJ, Hirano I (2016) Severity of endoscopically identified esophageal rings correlates with reduced esophageal distensibility in eosinophilic esophagitis. Endoscopy 48(9):794–801. https://doi.org/10.1055/s-0042-107340
DeHaan RK, Frelich MJ, Gould JC (2016) Intraoperative assessment of esophagogastric junction distensibility during laparoscopic Heller myotomy. Surg Laparosc Endosc Percutan Tech 26(2):137–140. https://doi.org/10.1097/SLE.0000000000000245
Fukazawa K, Furuta K, Adachi K, Moritou Y, Saito T, Kusunoki R, Uno G, Shimura S, Aimi M, Ohara S, Ishihara S, Kinoshita Y (2014) Effects of mosapride on esophageal motor activity and esophagogastric junction compliance in healthy volunteers. J Gastroenterol 49(9):1307–1313. https://doi.org/10.1007/s00535-013-0876-0
Gentile N, Katzka D, Ravi K, Trenkner S, Enders F, Killian J, Kryzer L, Talley NJ, Alexander J (2014) Oesophageal narrowing is common and frequently under-appreciated at endoscopy in patients with oesophageal eosinophilia. Aliment Pharmacol Ther 40(11–12):1333–1340. https://doi.org/10.1111/apt.12977
van Herwaarden MA, Samsom M, Smout AJ (2000) Excess gastroesophageal reflux in patients with hiatus hernia is caused by mechanisms other than transient LES relaxations. Gastroenterology 119(6):1439–1446. https://doi.org/10.1053/gast.2000.20191
Hirano I, Pandolfino JE, Boeckxstaens GE (2017) Functional lumen imaging probe for the management of esophageal disorders: expert review from the clinical practice updates committee of the AGA institute. Clin Gastroenterol Hepatol 15(3):325–334. https://doi.org/10.1016/j.cgh.2016.10.022
Ilczyszyn A, Botha AJ (2014) Feasibility of esophagogastric junction distensibility measurement during Nissen fundoplication. Dis Esophagus 27(7):637–644. https://doi.org/10.1111/dote.12130
Kappelle WFW, Bogte A, Siersema PD (2015) Hydraulic dilation with a shape-measuring balloon in idiopathic achalasia: a feasibility study. Endoscopy 47(11):1028–1034. https://doi.org/10.1055/s-0034-1392481
Kwiatek MA, Pandolfino JE, Hirano I, Kahrilas PJ (2010) Esophagogastric junction distensibility assessed with an endoscopic functional luminal imaging probe (EndoFLIP). Gastrointest Endosc 72(2):272–278. https://doi.org/10.1016/j.gie.2010.01.069
Kwiatek MA, Hirano I, Kahrilas PJ, Rothe J, Luger D, Pandolfino JE (2011) Mechanical properties of the esophagus in eosinophilic esophagitis. Gastroenterology 140(1):82–90. https://doi.org/10.1053/j.gastro.2010.09.037
Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood SE, Bonis PA, Burks AW, Chehade M, Collins MH, Dellon ES, Dohil R, Falk GW, Gonsalves N, Gupta SK, Katzka DA, Lucendo AJ, Markowitz JE, Noel RJ, Odze RD, Putnam PE, Richter JE, Romero Y, Ruchelli E, Sampson HA, Schoepfer A, Shaheen NJ, Sicherer SH, Spechler S, Spergel JM, Straumann A, Wershil BK, Rothenberg ME, Aceves SS (2011) Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol 128(1):3–20. https://doi.org/10.1016/j.jaci.2011.02.040
Lin Z, Nicodème F, Boris L, Lin CY, Kahrilas PJ, Pandolfino JE (2013) Regional variation in distal esophagus distensibility assessed using the functional luminal imaging probe (FLIP). Neurogastroenterol Motil 25(11):765–771. https://doi.org/10.1111/nmo.12205
Lottrup C, McMahon BP, Ejstrud P, Ostapiuk MA, Funch-Jensen P, Drewes AM (2016) Esophagogastric junction distensibility in hiatus hernia. Dis Esophagus 29(5):463–471. https://doi.org/10.1111/dote.12344
Nathanson LK, Brunott N, Cavallucci D (2012) Adult esophagogastric junction distensibility during general anesthesia assessed with an endoscopic functional luminal imaging probe (EndoFLIP??). Surg Endosc 26(4):1051–1055. https://doi.org/10.1007/s00464-011-1996-3
Nicodème F, Hirano I, Chen J, Robinson K, Lin Z, Xiao Y, Gonsalves N, Kwasny MJ, Kahrilas PJ, Pandolfino JE (2013) Esophageal distensibility as a measure of disease severity in patients with eosinophilic esophagitis. Clin Gastroenterol Hepatol 11(9):1101–1107. https://doi.org/10.1016/j.cgh.2013.03.020
Pandolfino JE, De Ruigh A, Nicodème F, Xiao Y, Boris L, Kahrilas PJ (2013) Distensibility of the esophagogastric junction assessed with the functional lumen imaging probe (FLIP???) in achalasia patients. Neurogastroenterol Motil 25(6):496–501. https://doi.org/10.1111/nmo.12097
Perretta S, Dallemagne B, McMahon B, D’Agostino J, Marescaux J (2011) Improving functional esophageal surgery with a “smart” bougie: endoflip. Surg Endosc 25(9):3109. https://doi.org/10.1007/s00464-011-1611-7
Regan J, Walshe M, Rommel N, Mcmahon BP (2013) A new evaluation of the upper esophageal sphincter using the functional lumen imaging probe: a preliminary report. Dis Esophagus 26(2):117–123. https://doi.org/10.1111/j.1442-2050.2012.01331.x
Rieder E, Swanström LL, Perretta S, Lenglinger J, Riegler M, Dunst CM (2013) Intraoperative assessment of esophagogastric junction distensibility during per oral endoscopic myotomy (POEM) for esophageal motility disorders. Surg Endosc 27(2):400–405. https://doi.org/10.1007/s00464-012-2484-0
Rohof WO, Hirsch DP, Kessing BF, Boeckxstaens GE (2012) Efficacy of treatment for patients with achalasia depends on the distensibility of the esophagogastric junction. Gastroenterology 143(2):328–335. https://doi.org/10.1053/j.gastro.2012.04.048
Schoeman MN, Tippett MD, Akkermans LMA, Dent J, Holloway RH (1995) Mechanisms of gastroesophageal reflux in ambulant healthy human subjects. Gastroenterology 108(1):83–91. https://doi.org/10.1016/0016-5085(95)90011-X
Schoepfer AM, Gonsalves N, Bussmann C, Conus S, Simon H-U, Straumann A, Hirano I (2010) Esophageal dilation in eosinophilic esophagitis: effectiveness, safety, and impact on the underlying inflammation. Am J Gastroenterol 105(5):1062–1070. https://doi.org/10.1016/S0739-5930(10)79559-3
Teitelbaum EN, Soper NJ, Pandolfino JE, Kahrilas PJ, Hirano I, Boris L, Nicodème F, Lin Z, Hungness ES (2015) Esophagogastric junction distensibility measurements during Heller myotomy and POEM for achalasia predict postoperative symptomatic outcomes. Surg Endosc 29(3):522–528. https://doi.org/10.1007/s00464-014-3733-1
Tucker E, Sweis R, Anggiansah A, Wong T, Telakis E, Knowles K, Wright J, Fox M (2013) Measurement of esophago-gastric junction cross-sectional area and distensibility by an endolumenal functional lumen imaging probe for the diagnosis of gastro-esophageal reflux disease. Neurogastroenterol Motil 25(11):904–910. https://doi.org/10.1111/nmo.12218
Verlaan T, Rohof WO, Bredenoord AJ, Eberl S, Rösch T, Fockens P (2013) Effect of peroral endoscopic myotomy on esophagogastric junction physiology in patients with achalasia. Gastrointest Endosc 78(1):39–44. https://doi.org/10.1016/j.gie.2013.01.006
Wu PI, Szczesniak MM, Maclean J, Choo L, Quon H, Graham PH, Zhang T, Cook IJ (2017) Clinical utility of a functional lumen imaging probe in management of dysphagia following head and neck cancer therapies. Endoscopy 49(9):848–854. https://doi.org/10.1055/s-0043-110670
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Lenglinger, J. (2017). Impedance Planimetry. In: Ekberg, O. (eds) Dysphagia. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/174_2017_161
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DOI: https://doi.org/10.1007/174_2017_161
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