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Casabona-Francés S, Sanz-García A, Ortega GJ, Santander C, Perez-Fernandez T, Majano P, Olalla JM, Juárez-Tosina R, Mueller R, Attwood S, Lucendo A. A New Method to Evaluate Lower Esophageal Distension Capacity in Eosinophilic Esophagitis by Using Functional Lumen Imaging Probe (EndoFLIP™). Diagnostics (Basel) 2024; 14:218. [PMID: 38275466 PMCID: PMC10814586 DOI: 10.3390/diagnostics14020218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
Endoluminal functional lumen impedance planimetry (EndoFLIPTM) has become the gold standard to evaluate esophageal distensibility, although the study itself and its analysis present challenges. We propose here a new method to assess lower esophageal distension capacity that overcomes several limitations of prior approaches, including incomplete and corrupted EndoFLIPTM recordings. Esophageal distension capacity was evaluated with a 16-channel EndoFLIPTM in 10 controls and 14 patients with eosinophilic esophagitis (EoE). Controls were evaluated once. EoE patients were evaluated at baseline and after at least six weeks of treatment with orodispersible budesonide tablets, 1 mg bd. Balloon volumes were increased by 5 mL stepwise, either reaching a maximum volume of 60 mL or a maximum balloon pressure of 60 mmHg. Recordings were analyzed with a homemade R script. The mean esophageal diameter at 60 mL, D (60 mL), was calculated or extrapolated depending on whether the 60 mL volume was reached. By fitting a Michaelis-Menten curve across all measured diameters throughout all constant volume steps, the mean D (60 mL) was estimated. For control subjects, the mean ± SD value of D (60 mL) was 17.08 ± 1.69 mm, and for EoE patients at baseline, D (60 mL) was 14.51 ± 2.68 mm. After six weeks of treatment of EoE patients, D (60 mL) significantly increased to 16.22 ± 1.86 mm (paired Wilcoxon signed test: p = 0.0052), although the values for control subjects were not reached. The estimated mean esophageal diameter at 60 mL is a good proxy for esophageal distension capacity, which correlates with clinical outcomes in EoE. The method presented in this study overcomes difficulties encountered during the standard measurement protocol, allowing the analysis of recordings from incomplete and corrupted registries.
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Affiliation(s)
- Sergio Casabona-Francés
- Department of Gastroenterology and Hepatology, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (S.C.-F.); (C.S.); (T.P.-F.); (P.M.)
- Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBERehd), 28029 Madrid, Spain;
- Instituto de Investigación Sanitaria Princesa (IIS-IP), 28006 Madrid, Spain
| | - Ancor Sanz-García
- Data Analysis Unit, Instituto de Investigación, Sanitaria Hospital Universitario de la Princesa, 28006 Madrid, Spain;
| | - Guillermo J. Ortega
- Data Analysis Unit, Instituto de Investigación, Sanitaria Hospital Universitario de la Princesa, 28006 Madrid, Spain;
- Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET, Buenos Aires C1425FQB, Argentina
- Science and Technology Department, National University of Quilmes, Bernal B1876BXD, Argentina
| | - Cecilio Santander
- Department of Gastroenterology and Hepatology, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (S.C.-F.); (C.S.); (T.P.-F.); (P.M.)
- Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBERehd), 28029 Madrid, Spain;
- Instituto de Investigación Sanitaria Princesa (IIS-IP), 28006 Madrid, Spain
| | - Teresa Perez-Fernandez
- Department of Gastroenterology and Hepatology, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (S.C.-F.); (C.S.); (T.P.-F.); (P.M.)
- Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBERehd), 28029 Madrid, Spain;
- Instituto de Investigación Sanitaria Princesa (IIS-IP), 28006 Madrid, Spain
| | - Pedro Majano
- Department of Gastroenterology and Hepatology, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (S.C.-F.); (C.S.); (T.P.-F.); (P.M.)
- Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBERehd), 28029 Madrid, Spain;
- Instituto de Investigación Sanitaria Princesa (IIS-IP), 28006 Madrid, Spain
| | - José Maria Olalla
- Department of Pathology, Hospital General La Mancha Centro, 13600 Alcázar de San Juan, Spain; (J.M.O.); (R.J.-T.)
| | - Rocio Juárez-Tosina
- Department of Pathology, Hospital General La Mancha Centro, 13600 Alcázar de San Juan, Spain; (J.M.O.); (R.J.-T.)
| | - Ralph Mueller
- Department of Clinical Research and Development, Dr. Falk Pharma GmbH, 79108 Freiburg, Germany;
| | - Stephen Attwood
- Department of Health Services Research, Durham University, Durham DH1 3LE, UK;
| | - Alfredo Lucendo
- Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBERehd), 28029 Madrid, Spain;
- Department of Gastroenterology, Hospital General de Tomelloso, 13700 Tomelloso, Spain
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), 45071 Toledo, Spain
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