Functional Lumen Imaging Probe (FLIP) Predictors of Esophageal Clearance in Symptomatic Post-Fundoplication Patients: Opening Diameter Has Greater Value Than Distensibility Index

Background: Clinically relevant esophagogastric junction metrics on functional lumen imaging probe (FLIP) in post-fundoplication patients remain unclear. Methods: 63 symptomatic post-fundoplication patients underwent FLIP, barium esophagram, and high-resolution manometry. Logistic regressions and receiver-operating characteristic curves for distensibility index (DI) at 60 mL and maximal diameter were generated to predict impaired clearance. Results: Maximal diameter (OR:0.77, CI:0.62-0.96,p=0.02, AUROC=0.73), but not DI, independently predicted impaired clearance. Diameter >16.5 mm achieved >90% sensitivity for normal clearance; DI <2.0 mm 2 /mmHg and diameter <8 mm were >90% specific for impaired clearance. Conclusions: Maximal diameter on post-fundoplication FLIP predicts impaired clearance and discriminates better than DI.