Functional Lumen Imaging Probe Panometry Findings in Obese Patient Populations

BACKGROUND: Few data are available on functional lumen imaging probe (FLIP) findings specifically in obese patients. We aimed to evaluate FLIP metrics in obese patients who had not undergone bariatric surgery and in those who had sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). We also sought correlations of FLIP abnormalities with esophageal symptoms and HRM findings. METHODS: We identified obese patients who had FLIP performed during workups either for a first bariatric operation (surgery-naïve patients), or for surgical revision of SG and RYGB operations that resulted in inadequate weight loss. We recorded esophageal symptoms, HRM data, and FLIP metrics. KEY RESULTS: We identified 228 eligible patients (87 surgery-naïve, 90 SG, 51 RYGB). Dysphagia and chest pain were frequent symptoms in all groups. Median EGJ diameter and EGJ-DI were similar in surgery-naïve and postsurgical patients, but subgroup analysis of symptomatic patients with no HRM diagnosis revealed reduced EGJ opening in 12%. Abnormal FLIP response patterns were common (69% surgery-naïve, 74% SG, 65% RYGB) with higher ACR rates in SG (46.7% vs. 29.9%, p = 0.026) and RYGB (41.2% vs. 29.9%, p = 0.189) and lower SRCR rates in SG (11.1% vs. 24.1%, p = 0.021) and RYGB (5.9% vs. 24.1%, p = 0.006) compared to surgically naïve patients. There were no significant associations between FLIP contractile response patterns and symptoms or HRM diagnoses. CONCLUSIONS: Dysphagia and chest pain are common in obese patients, and most obese patients (with or without bariatric surgery) have FLIP contractile response abnormalities that do not correlate with HRM findings. FLIP findings appear to be especially valuable in obese patients who have esophageal symptoms with no HRM diagnosis.