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Esophagogastric Junction Outflow Obstruction: Current Approach to Diagnosis and Management

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Abstract

Purpose of Review

We summarize the current epidemiology, presentation, diagnostic workup, and treatment of esophagogastric junction outflow obstruction (EGJOO). We also propose a treatment algorithm based upon the literature and our personal clinical experience.

Recent Findings

EGJOO can be caused by functional obstruction (akin to achalasia), mechanical obstruction, medications, or artifact. High-resolution esophageal manometry is currently the gold standard of diagnosis. Recent research on FLIP (functional lumen imaging probe) and timed barium support use as adjunctive testing. The diagnostic yield of cross-sectional imaging is low.

Summary

Current diagnostic testing and treatment should be targeted to the suspected underlying etiology and clinical presentation of EGJOO. If functional obstruction is present with significant and persistent dysphagia, and either an abnormal FLIP or timed barium swallow, we consider therapy aimed at LES disruption (similar to achalasia). Pharmacologic therapy has a limited role. More research is needed on diagnostic and treatment modalities.

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Correspondence to John O. Clarke.

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JC is a consultant for Medtronic. Thomas A. Zikos, George Triadafilopoulos, and John O. Clarke declare no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Zikos, T.A., Triadafilopoulos, G. & Clarke, J.O. Esophagogastric Junction Outflow Obstruction: Current Approach to Diagnosis and Management. Curr Gastroenterol Rep 22, 9 (2020). https://doi.org/10.1007/s11894-020-0743-0

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Keywords

  • Esophagogastric junction outflow obstruction
  • EGJOO
  • IRP
  • Chicago classification
  • High-resolution esophageal manometry
  • Opioids
  • Functional lumen imaging probe