P1802 - EndoFLIP as a Novel Methodology to Diagnose Postobesity Surgery Esophageal Dysfunction

Monday, October 23, 2023

10:30 AM – 4:15 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

Bibek Saha, MD

Mayo Clinic
Rochester, MN

Bibek Saha, MD, Khushboo Gala, MBBS, Mark Hanscom, MD, Omar Ghanem, MD, Karthik Ravi, MD, Andrew Storm, MD, Barham Abu Dayyeh, MD, MPH
Mayo Clinic, Rochester, MN

Introduction: Esophageal dysmotility, dysphagia, and worsening of GERD can develop after bariatric surgery. The prevalence of postsurgical dysphagia is 13.7%, causes of which include achalasia and postobesity surgery esophageal dysfunction (POSED). POSED is an achalasia-like motility disorder characterized mainly by aperistalsis of the esophagus and elevated intragastric pressure (≥30mmHg). While high resolution manometry is the gold standard, EndoFLIP (endoluminal functional lumen imaging probe) is a newer modality that can also play a role in the diagnosis of esophageal dysmotility. We review a case of POSED diagnosed with EndoFLIP.

Case Description/Methods:

A 47-year-old female with a history of obesity s/p open roux-en-Y gastric bypass (RYGB) in 2004, cerebral palsy and alcohol use disorder presented to the post-bariatric surgery clinic for evaluation of RYGB revision. Specifically, she developed progressive GERD and dysphagia that started 2 years after surgery. She also reported a constellation of chronic symptoms including cough, dyspnea, pleuritic chest pain, recurrent aspiration and regurgitation that was often blood tinged.

Previously, she was evaluated at a local hospital and was found to have a cavitary lung mass in the left lower lobe (LLL) on imaging. Despite numerous antibiotic courses for aspiration pneumonitis, she did not have resolution of symptoms or the lung mass. After comprehensive evaluation by ID and Pulmonology at our center, she was diagnosed with chronic aspiration in the setting of prior RYGB leading to lung parenchyma destruction and recurrent infections. She was referred to the Bariatric clinic for further evaluation.

She underwent EGD, which revealed an 8cm gastric pouch with a 3cm sliding hiatal hernia but no anatomical obstruction. Endoflip demonstrated pan-pressurization of the gastric pouch with diminished, disorganized esophageal contractions, which in the absence of obstruction was consistent with POSED. The lower esophageal sphincter distensibility and diameter on balloon inflation to 60ml were 2.82mmHg and 11.9mm, respectively. For management of symptoms, she underwent LLL lobectomy followed by pouch revision. On followup, she reported symptom resolution.

Discussion: POSED occurs in ~5.2% of post-bariatric surgery patients. We report successful diagnosis of POSED with use of EndoFLIP. Our patient developed delayed and end-stage complication due to undiagnosed POSED. Newer tools like EndoFLIP may help with earlier diagnosis, and potentially improved outcomes after POSED.

Disclosures:

Bibek Saha indicated no relevant financial relationships.

Khushboo Gala indicated no relevant financial relationships.

Mark Hanscom indicated no relevant financial relationships.

Omar Ghanem indicated no relevant financial relationships.

Karthik Ravi indicated no relevant financial relationships.

Andrew Storm: Apollo – Consultant, Grant/Research Support. Boston Scientific – Consultant, Grant/Research Support. Endogenex – Consultant, Grant/Research Support. Endo-TAGSS – Consultant. Enterasense – Grant/Research Support. Intuitive – Consultant. Medtronic – Consultant, Grant/Research Support. MGI Medical – Consultant. Microtech – Consultant. Olypmus – Consultant. OnePass – Grant/Research Support. Pillsense – Consultant, Grant/Research Support.

Barham Abu Dayyeh: Apollo Endosurgery – Consultant, Grant/Research Support. Aspire Bariatrics – Grant/Research Support. Boston Scientific – Consultant, Grant/Research Support. Cairn Diagnostics – Grant/Research Support. DyaMx – Consultant. Endogastric Solutions – Speakers Bureau. Endo-TAGSS – Consultant. GI Dynamics – Grant/Research Support. Johnson and Johnson – Speakers Bureau. Medtronic – Grant/Research Support. Olympus – Speakers Bureau. Spatz Medical – Grant/Research Support. USGI Medical – Consultant, Grant/Research Support.

Bibek Saha, MD, Khushboo Gala, MBBS, Mark Hanscom, MD, Omar Ghanem, MD, Karthik Ravi, MD, Andrew Storm, MD, Barham Abu Dayyeh, MD, MPH. P1802 - EndoFLIP as a Novel Methodology to Diagnose Postobesity Surgery Esophageal Dysfunction, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.