Regional variation in distal esophagus distensibility assessed using the functional luminal imaging probe (FLIP)

BackgroundThis study aimed to evaluate the spatial variation in esophageal distensibility in normal subjects using a novel multichannel functional luminal imaging probe (FLIP). MethodsTen healthy subjects (four men, age 21-49years) were evaluated during endoscopy with a high-resolution impedance planimetry probe (FLIP) positioned through the esophagogastric junction (EGJ) and distal 10cm of the esophageal body. Stepwise bag distensions using 5-mL increments from 0 to 60mL were conducted, and simultaneous measurements of cross-sectional area (CSA) and the associated intrabag pressure from each subject were analyzed using a customized MATLAB program. The distensibility along the esophagus was determined and compared between the EGJ and interval locations at 2-5cm and 6-10cm above the EGJ. Key ResultsThe pressure-CSA relationship was nearly linear among sites at lower pressures (0 to 7.5mmHg) and reached a distension plateau at pressures ranging from 8 to 24mmHg. The location of greatest distensibility was 4cm above the EGJ. Although the CSAs of individual recording loci were not significantly different, there was a significant difference between the mean CSAs when comparing the region 2 to 5cm proximal to EGJ with that 6 to 10cm proximal to the EGJ. Conclusions & InferencesThere were significant regional differences in distensibility along the distal esophagus with lower values in the proximal part compared with more distal part. The greatest distensibility was noted to occur at about 4cm above the EGJ in close proximity to the location of the contractile deceleration point and phrenic ampulla.