# A Tough Pill to Swallow: Demonstration of Esophageal Physiologic Events Explaining Severe Dysphagia Captured on EndoFLIP After LINX Procedure

## TL;DR

A patient experienced severe difficulty swallowing after a LINX procedure, and EndoFLIP imaging helped identify the cause and suggest a new treatment approach.

## Contribution

The paper demonstrates a novel physiologic approach to treating post-LINX dysphagia by using EndoFLIP to guide dietary changes.

## Key findings

- EndoFLIP showed narrowing and stiffness at lower volumes but improved distensibility at larger volumes.
- Ingesting larger solid boluses was suggested as a treatment to improve swallowing.
- The approach avoided additional invasive procedures.

## Abstract

Dysphagia is a common symptom after magnetic sphincter augmentation, a minimally invasive antireflux alternative to laparoscopic Nissen fundoplication. A 69-year-old woman underwent LINX procedure in 2017 for GERD symptoms, after which she had the onset of dysphagia. EndoFLIP demonstrated narrowing and stiffness at lower volumes but acceptable distensibility at the largest balloon volume. The treatment plan aimed to improve swallowing by ingesting larger solid boluses and avoiding additional invasive procedures. This visualization of the obstruction on EndoFLIP presented a more physiologic approach to treatment with ingesting larger, rather than smaller, solid food boluses.