Utility of functional lumen imaging probe in esophageal measurements and dilations: a single pediatric center experience

Background: Pediatric esophageal stenosis can be challenging to manage due to post-dilation tissue response involving fibroblast activity resulting in scar reformation. The functional lumen imaging probe (FLIP) uses high-resolution impedance planimetry to measure key luminal parameters during a volume-controlled distension. We sought to evaluate the safety as well as possible settings of EndoFLIP and EsoFLIP in the pediatric population. Method: We performed a retrospective chart review of all patients that had EndoFLIP (with and without balloon dilation) or EsoFLIP done between July 2017 and May 2018. Results: Eighteen patients were identified and 19 FLIP procedures were performed during esophagogastroduodenoscopy (10 EndoFLIP, 6 EndoFLIP + traditional balloon dilation, 3 EsoFLIP). Median age for the population was 13.7 years. Dysphagia was the most common chief complaint prior to endoscopic intervention. EndoFLIP measurements were most commonly taken at 20 ml and/or 30 ml of infusion. Diameter, compliance, cross-sectional area, and distensibility index were similar between infusion volumes. Median procedure time of the EndoFLIP + traditional balloon dilation group was longer (60.5 min) than the median procedure time of the EsoFLIP group (35 min, p = 0.12). Median fluoroscopy time of the EndoFLIP + traditional balloon dilation group was 0.6 min and the median fluoroscopy time of the EsoFLIP group was 0.5 min (p = 0.79). EndoFLIP + traditional balloon dilation was associated with a smaller diameter increase compared to EsoFLIP (2.2 mm vs. 4 mm; p = 0.09). There were no complications. Conclusion: Functional lumen imaging probe (FLIP) can safely provide important luminal measurements in pediatric patients with esophageal stenosis, and may guide therapy. Esophageal dilation using EsoFLIP may yield a larger diameter change and may potentially reduce procedure time when compared to traditional balloon dilation. Pediatric patients with epidermolysis bullosa and esophageal stenosis responded well to EsoFLIP dilation.