P0513 - An Evaluation and Comparison of Timed Barium Esophagram and EndoFLIP in Patients With Clinically Relevant EGJOO vs Normal Manometric Controls

Anthony Wachnik, BSc, Anuj Jailwala, BSc, Chiagoziem Ogbonna, MD, Makell Brown, BSPH, Steven Clayton, MD
Wake Forest University School of Medicine, Winston-Salem, NC

Introduction: Clinically relevant esophagogastric outflow obstruction (EGJOO) is a rare esophageal motility disorder that can be challenging to diagnose. Many cases of EGJOO found on high-resolution manometry (HRM) are attributable to artifact. Supportive investigations, such as the timed barium esophagram (TBE) and the endoscopic functional lumen imaging probe (EndoFLIP) are useful in diagnosing clinically relevant EGJOO. This study aims to further characterize clinically relevant EGJOO by comparing its HRM, TBE, and EndoFLIP findings to those of a normal patient population.

Methods: Our study includes all patients aged > 18 who have had HRM studies done at our facility in the last five years. A chart review of the electronic medical records identified patients with confirmed clinically relevant EGJOO and a normal HRM diagnosis who had either TBE and/or EndoFLIP performed. We also collected demographic information, treatments, and clinical outcomes. Descriptive statistics and pairwise statistical tests of association were computed across the groups. Fisher’s exact test and Pearson’s chi-squared test were used for categorical covariates whereas the Wilcoxon and Kruskal-Wallis rank sum tests were used for continuous covariates. All statistical analyses were performed in R version 4.1.1 (2021-08-10).

Results: Table 1 shows there were notable differences in the age (EGJOO 63 vs. Normal 55, p=0.033) and BMI (EGJOO 27 kg/m2 vs. Normal 30 kg/m2, p=0.049) between the two groups. While White, Caucasian was the most represented racial background in both groups, there was no statistical difference in race (p=0.16). When comparing HRM data, patients with EGJOO exhibited significantly higher LES residual pressure (42 mmHg vs. 27 mmHg, p= < 0.001), LES basal pressure (20 mmHg vs. 10 mmHg, p= < 0.001), and DCI (3,211 mmHg-cm-s vs. 1,708 mmHg-cm-s, p=0.023). There was a clinically significant increase in TBE column height at 1 minute for patients with EGJOO (6.2 cm vs. 0.0 cm, p=0.079). EndoFLIP data did not yield any remarkable differences.

Discussion: This retrospective cohort study indicates that significant differences in HRM exist for patients with EGJOO, including elevated LES residual pressure, increased LES basal pressure, and higher DCI. Patients with EGJOO had a lower BMI, possibly due to reduced oral intake. When comparing EndoFLIP and TBE, TBE height a 1 minute provided greater utility in differentiating patients. EndoFLIP did not make any significant distinction between the two groups.


Disclosures:


Anthony Wachnik, BSc, Anuj Jailwala, BSc, Chiagoziem Ogbonna, MD, Makell Brown, BSPH, Steven Clayton, MD. P0513 - An Evaluation and Comparison of Timed Barium Esophagram and EndoFLIP in Patients With Clinically Relevant EGJOO vs Normal Manometric Controls, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.