# Poster Session II A331 ANALYSIS OF ESOPHAGEAL CHARACTERISTICS IN CHILDREN WITH ESOPHAGEAL ATRESIA USING FLIP PANOMETRY

## TL;DR

The study uses FLIP panometry to analyze esophageal function in children with esophageal atresia, revealing correlations between anastomosis characteristics and symptoms like dysphagia and food impaction.

## Contribution

This is the first study to evaluate FLIP panometry in children with esophageal atresia, providing insights into esophageal motility and anastomosis characteristics.

## Key findings

- A distensibility index of less than 15mm at the distensibility plateau correlates with food impaction and dysphagia.
- Secondary peristalsis was absent or diminished in 56% of patients, with a trend toward reflux esophagitis in these cases.
- FLIP panometry is feasible in EA children as young as infants, though caution is needed in those with severe tracheomalacia.

## Abstract

Esophageal atresia (EA) is the most common congenital abnormality of the oesophagus and is associated with long-term complications including dysmotility, dysphagia, gastroesophageal reflux disease, and eosinophilic oesophagitis (EoE).

To assess esophageal mechanical and functional properties in children with EA and to evaluate the utility of Functional Lumen Imaging Probe (FLIP) panometry in this patient population.

We retrospectively analysed FLIP panometry studies performed during endoscopic follow-up in EA patients. An 8- or 16-cm balloon was selected according to patient height. Where possible, we applied the 2025 Dallas criteria for data analysis. Measurements included esophagogastric junction (EGJ) characteristics, distensibility plateau (DP), compliance over 8cm and secondary peristalsis.

Thirty-two children with EA were included, with a median age of 7,4 years (9 months – 17 years). DP corresponded with the anastomosis in most patients, with a median DP of 14mm and a distensibility index (DI) at DP of 4,0mm^2/mmHg. Both DP and DI at DP correlated with age and height. A DP of less than 15mm was associated with food impaction, while DI at DP was correlated with both dysphagia and food impaction.

Secondary peristalsis was absent in 34%, diminished in 22%, normal in 28%, disordered/impaired in 13%, and spastic in 3%. A trend towards reflux oesophagitis was observed in patients with absent or diminished peristalsis. An EGJ DI of more than 4mm^2/mmHg significantly increased esophagitis risk.

Reduced esophageal compliance was found in 37,5%, but was not significantly correlated with age nor DP. EoE was correlated with reduced compliance, but not with secondary peristalsis or anastomosis characteristics. The median maximal pressure during the procedure was 70mmHg. Maximal filling volume was reached in only 41% of patients.

Three infants (≤ 2 years old) with severe tracheomalacia developed mild to moderate respiratory problems during balloon filling due to external trachea compression. No other complications occurred.

FLIP panometry is feasible in children with EA from a young age and provides valuable insights into the anastomosis characteristics, esophageal anatomy and motility. Caution is warranted in infants with severe tracheomalacia.

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