{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T20:32:00Z","timestamp":1786653120924,"version":"build-2736575974"},"reference-count":28,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T00:00:00Z","timestamp":1752451200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2025,12]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Functional lumen imaging probe (FLIP) utility is established in treatment\u2010na\u00efve achalasia but less clear following lower esophageal sphincter (LES) directed therapy.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Achalasia patients with LES directed therapy across three tertiary care centers between 2017 and 2024 with post\u2010treatment FLIP and timed barium esophagram (TBE) were retrospectively identified. Reduced esophagogastric junction (EGJ) opening was defined by distensibility index (DI) <\u20092\u2009mm\n 2<\/jats:sup>\n \/mmHg and diameter\u2009<\u200912\u2009mm. Abnormal emptying on TBE was defined as column height \u2265\u20095\u2009cm at 5\u2009min and\/or retained tablet. Eckardt scores \u2264\u20093 defined clinical response.\n <\/jats:p>\n <\/jats:sec>\n \n Key Results<\/jats:title>\n \n The study included 222 patients (46% peroral endoscopic myotomy, 46% laparoscopic Heller myotomy, 8% pneumatic dilation) with a median of 1.4\u2009years to post\u2010treatment TBE\/FLIP. Abnormal emptying on TBE was associated with a narrower median EGJ diameter (13.2 vs. 14.8\u2009mm,\n p<\/jats:italic>\n \u2009=\u20090.008), a greater frequency of EGJ diameter\u2009<\u200912\u2009mm (36% vs. 21%,\n p<\/jats:italic>\n \u2009=\u20090.012), and a smaller change in EGJ diameter (+4.6 vs. +8.6\u2009mm,\n p<\/jats:italic>\n \u2009=\u20090.002). Abnormal emptying on TBE occurred more frequently in patients with EGJ DI <\u20092\u2009mm\n 2<\/jats:sup>\n \/mmHg (8.5% vs. 2.6%,\n p<\/jats:italic>\n \u2009=\u20090.052), but was not associated with median EGJ DI (4.5 vs. 5.1\u2009mm\n 2<\/jats:sup>\n \/mmHg,\n p<\/jats:italic>\n \u2009=\u20090.29) nor median change in EGJ DI (+2.9 vs. +3.9\u2009mm\n 2<\/jats:sup>\n \/mmHg,\n p<\/jats:italic>\n \u2009=\u20090.25). Patients with reduced EGJ DI or EGJ diameter more often had abnormal TBE (37% vs. 22%,\n p<\/jats:italic>\n \u2009=\u20090.012). Only the change in DI (+3.8 vs. +1.5\u2009mm\n 2<\/jats:sup>\n \/mmHg,\n p<\/jats:italic>\n \u2009=\u20090.012) and diameter (+8.2 vs. +1.6\u2009mm,\n p<\/jats:italic>\n \u2009=\u20090.002) on FLIP was associated with a clinical response based on Eckardt \u2264\u20093.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Inferences<\/jats:title>\n FLIP following achalasia therapy generally correlates with TBE, although discrepant findings are not uncommon. In particular, FLIP EGJ\u2010diameter has a strong association with esophageal emptying on TBE. Both TBE and FLIP have limited association with clinical response based on Eckardt, with change in DI and diameter on FLIP most strongly associated. Consequently, FLIP as part of multimodal assessment appears useful in the longitudinal follow\u2010up of treated achalasia.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/nmo.70121","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T06:03:08Z","timestamp":1752559388000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Functional Lumen Imaging Probe as Part of Multimodality Assessment of Esophagogastric Junction Opening Is Important in Longitudinal Follow\u2010Up of Patients With Treated Achalasia"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8296-1029","authenticated-orcid":false,"given":"Amrit K.","family":"Kamboj","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology Cedars\u2010Sinai Medical Center Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shubham","family":"Sood","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon","family":"Truong","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Cedars\u2010Sinai Medical Center Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis M.","family":"Wong Kee Song","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Cedars\u2010Sinai Medical Center Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Wells","sequence":"additional","affiliation":[{"name":"Division of Radiology Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis","family":"Wigle","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. Chamil","family":"Codipilly","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Cedars\u2010Sinai Medical Center Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana L.","family":"Snyder","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Cedars\u2010Sinai Medical Center Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey A.","family":"Alexander","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Cedars\u2010Sinai Medical Center Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cadman","family":"Leggett","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Cedars\u2010Sinai Medical Center Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan J.","family":"Lennon","sequence":"additional","affiliation":[{"name":"Division of Clinical Trials and Biostatistics Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9346-7085","authenticated-orcid":false,"given":"Andree","family":"Koop","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Mayo Clinic Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5350-4654","authenticated-orcid":false,"given":"Marcelo","family":"Vela","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Mayo Clinic Scottsdale Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karthik","family":"Ravi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Mayo Clinic Rochester Minnesota 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