Can Esophageal Anatomy Help to Choose Between Functional Luminal Imaging Probe ( FLIP ) and Barium Esophagogram in Achalasia?

ABSTRACT Background Functional luminal imaging probe (FLIP) and barium esophagogram (BE) are complementary to high‐resolution manometry in achalasia. Anatomical changes and achalasia treatment could alter their interpretation. Our objective was to compare FLIP and BE for achalasia diagnosis and follow up and to evaluate the impact of anatomical changes. Methods One hundred and thirty patients who underwent FLIP were included. The indication of FLIP was a suspicion of achalasia (naive group, n = 68 patients) or symptoms after achalasia treatment (treated group, n = 62 patients). Esophago‐gastric junction distensibility index (EGJ‐DI) was considered low when < 3 mm 2 /mmHg for a 50 mL distension plateau. BE were reviewed for the presence of esophageal stasis and anatomical changes. FLIP and BE results were compared. Key Results EGJ‐DI was significantly lower in the naive group than in the treated group (2.7 mm 2 /mmHg vs. 5.6, p < 0.01). BE revealed abnormalities more frequently in the treated group than in the naive group (esophageal stasis 61% vs. 37%, p < 0.01; esophageal dilation 63% vs. 39%, p < 0.01; blown out myotomy 26% vs. 3%, p < 0.01). EGJ‐DI was lower in patients with stasis on BE compared to those without in the naive group but not in the treated group. Intrabag pressure tended to be lower in treated patients with stasis or blown out myotomy compared to those without. Conclusions & Inferences FLIP is complementary to BE and should be interpreted with caution, notably after achalasia treatment. Further studies should determine the respective place of BE and FLIP in patients' work up.