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Background: Functional lumen imaging probe (FLIP) panometry assesses esophageal motility in response to controlled volumetric distension. This study aimed to describe the physiomechanical states of the lower esophageal sphincter (LES) in response to serial filling/emptying regimes for esophageal motility disorders. Methods: Fourty‐five patients with absent contractile response on FLIP and diagnoses of normal motility (n = 6), ineffective esophageal motility (IEM; n = 8), scleroderma (SSc; n = 10), or nonspastic achalasia (n = 21) were included, as were 20 patient controls with normal motility on FLIP and manometry. LES diameter and pressure were measured after stepwise FLIP filling at 60 mL, 70 mL, and emptying to 60 mL with relative changes used to define physiomechanical states. Key Results: Passive dilatation after FLIP filling occurred in 63/65 (97%) patients among all diagnoses. After FLIP emptying, passive shortening occurred in 12/14 (86%) normal motility/IEM, 10/10 (100%) SSc, 9/21(43%) achalasia, and 16/20 (80%) controls, with auxotonic relaxation seen in 2/14 (14%) normal motility/IEM, 12/21 (57%) achalasia, and 4/20 (20%) controls. After achalasia treatment (LES myotomy), 21/21 (100%) achalasia had passive shortening after FLIP emptying. Conclusions & Inferences: Physiomechanical states of the LES can be determined via response to FLIP filling and emptying regimes. While passive shortening was the general response to FLIP emptying, auxotonic relaxation was observed in achalasia, which was disrupted by LES myotomy. Further investigation is warranted into the clinical impact on diagnosis and treatment of esophageal motility disorders. [ABSTRACT FROM AUTHOR]

Background & Aims: Functional lumen imaging probe (FLIP) Panometry evaluates esophageal motility at the time of sedated endoscopy and often parallels high-resolution manometry (HRM) performed in awake patients. This study aimed to assess the impact of endoscopic sedation on FLIP evaluation of esophageal motility., Methods: Adult patients who completed FLIP Panometry during sedated endoscopy and had a conclusive Chicago Classification v4.0 diagnosis on HRM were included in this retrospective study. HRM diagnoses relative to FLIP Panometry motility classifications were compared by sedation type used during FLIP, i.e. conscious sedation (CS) with midazolam and fentanyl or monitored anesthesia care (MAC) with propofol., Results: 454 patients (mean (SD) age 53 (17) years, 62% female) completed FLIP Panometry under CS (n=174, 38%) or MAC (n=280, 62%; 177/280 MAC included fentanyl). On comparison of CS vs MAC, HRM diagnoses within FLIP Panometry motility classifications did not differ (P=0.306 across all 5 FLIP Panometry classifications; P values 0.202-0.856 within specific FLIP classifications). The proportion of HRM diagnoses within each FLIP Panometry classification also did not differ between FLIP completed with CS vs MAC with fentanyl (P=0.098) or MAC without fentanyl (P=0.0261) CONCLUSIONS: Whether CS or MAC was used as sedation during FLIP did not have a clinically significant impact on the relationship between diagnosis on FLIP Panometry and HRM. This supports the validity of diagnosing esophageal motility disorders using FLIP Panometry during sedated endoscopy., (Copyright © 2024. Published by Elsevier Inc.)