# Validation of Functional Lumen Imaging Probe Panometry Esophageal Motility Classification Version 2.0: A Study of 805 Patients

## TL;DR

This study validates FLIP panometry v2.0 for diagnosing esophageal motility disorders in 805 patients, showing strong agreement with HRM.

## Contribution

The study validates FLIP panometry v2.0 classification for esophageal motility disorders against HRM diagnoses in a large multicenter cohort.

## Key findings

- Normal FLIP motility had 99% negative predictive value for EGJ outflow disorders.
- Non-spastic obstruction on FLIP had 91% positive predictive value for achalasia or EGJOO.
- FLIP v2.0 classifications frequently aligned with HRM/CCv4.0 diagnoses.

## Abstract

Functional lumen imaging probe (FLIP) panometry assesses esophageal motility during sedated endoscopy. Recently, the FLIP panometry motility classification was refined (v2.0) in the Dallas Consensus. This study aimed to characterize esophageal motility using the FLIP v2.0 classification scheme and compare its classifications with those of FLIP v1.0 and high‐resolution manometry (HRM) diagnoses on the basis of Chicago Classification v4.0 (CCv4.0).

805 adult patients who completed both FLIP and HRM at two tertiary esophageal centers were included; 704 with conclusive CCv4.0 diagnoses comprised the primary analysis, and 101 with inconclusive CCv4.0 diagnoses were also described. Esophagogastric junction (EGJ) opening and contractile response (CR) patterns were evaluated using 16‐cm FLIP during sedated endoscopy, with motility classifications defined by FLIP v1.0 and v2.0 criteria. HRM was classified per CCv4.0.

In the primary analysis, among the 137 (19%) patients with normal motility on FLIP panometry, 93% had normal motility or ineffective esophageal motility (IEM) on HRM. Normal motility on FLIP panometry had a 99% negative predictive value for disorders of EGJ outflow. Among the 163 (23%) patients with non‐spastic obstruction (defined by reduced EGJ opening and absent/diminished CR) on FLIP panometry, 91% had a conclusive disorder of EGJ outflow on HRM. Among the 37 patients with type III achalasia on HRM, 16 (43%) were classified as spastic obstruction on FLIP panometry.

FLIP panometry v2.0 categorized esophageal motility in a manner that frequently paralleled the HRM/CCv4.0 diagnoses. FLIP panometry offers a well‐tolerated approach that complements, or may be an alternative to, HRM for diagnosing esophageal motility disorders.

In a multicenter cohort of 805 patients, FLIP panometry v2.0 demonstrated strong diagnostic performance, with a 99% negative predictive value of normal motility for EGJ outflow disorders and a 91% positive predictive value of non‐spastic obstruction for achalasia or conclusive EGJOO, supporting its role as a valuable diagnostic tool.