{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T04:49:36Z","timestamp":1791434976850,"version":"4.3.3"},"reference-count":16,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Esophagogastric junction outflow obstruction (EGJOO) identified on high\u2010resolution manometry (HRM) remains a clinically heterogeneous and inconclusive finding. Additional complementary testing with functional lumen imaging probe (FLIP) or timed barium esophagram (TBE) is recommended to confirm clinically relevant obstruction. We aimed to assess the association of novel Four\u2010Dimensional (4D) HRM metrics against FLIP and TBE outcomes among symptomatic patients with inconclusive EGJOO on HRM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adult patients with inconclusive HRM\u2010EGJOO who completed corresponding FLIP and TBE studies were identified for inclusion in a cross\u2010sectional, retrospective study. Primary 4D HRM metrics of EGJ opening, EGJ distensibility index (4D EGJ\u2010DI), and 4D maximum EGJ diameter were analyzed relative to reference outcomes defined by FLIP and esophagram.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 123 patients (mean age 59\u2009years; 60% female), 4D EGJ\u2010DI and 4D maximum EGJ diameter differed significantly across FLIP and TBE outcome categories (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Lower 4D EGJ\u2010DI and lower 4D maximum EGJ diameter were associated with reduced EGJ opening on FLIP and abnormal retention on esophagram. There were 0 patients with normal EGJ opening on FLIP that had 4D maximum EGJ diameter &lt;\u20098.0\u2009mm and 0 patients with reduced EGJ opening on FLIP that had a 4D EGJ\u2010DI &gt;\u20092.2\u2009mm\n                      <jats:sup>2<\/jats:sup>\n                      \/mmHg and 4D maximum EGJ diameter &gt;\u200910.2\u2009mm.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>By integrating biomechanical assessment of EGJ opening with conventional pressure metrics, 4D HRM provides complementary physiologic information for evaluating esophageal motor function. This additional information may improve characterization of patients with inconclusive EGJOO.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nmo.70450","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T04:03:51Z","timestamp":1791432231000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Biomechanical Assessment During High\u2010Resolution Impedance Manometry Enhances Characterization of Inconclusive Esophagogastric Junction Outflow Obstruction"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-7656-6606","authenticated-orcid":false,"given":"Aidan D.","family":"Smires","sequence":"first","affiliation":[{"name":"Kenneth C. Griffin Esophageal Center of Northwestern Medicine, Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine Northwestern University  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2582-2070","authenticated-orcid":false,"given":"Wenjun","family":"Kou","sequence":"additional","affiliation":[{"name":"Kenneth C. Griffin Esophageal Center of Northwestern Medicine, Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine Northwestern University  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John E.","family":"Pandolfino","sequence":"additional","affiliation":[{"name":"Kenneth C. Griffin Esophageal Center of Northwestern Medicine, Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine Northwestern University  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3530-3621","authenticated-orcid":false,"given":"Panyavee","family":"Pitisuttithum","sequence":"additional","affiliation":[{"name":"Kenneth C. Griffin Esophageal Center of Northwestern Medicine, Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine Northwestern University  Chicago Illinois USA"},{"name":"Center of Excellence in Neurogastroenterology and Motility, Division of Gastroenterology, Department of Medicine, Faculty of Medicine Chulalongkorn University  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2699-3322","authenticated-orcid":false,"given":"Eric","family":"Goudie","sequence":"additional","affiliation":[{"name":"Kenneth C. Griffin Esophageal Center of Northwestern Medicine, Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine Northwestern University  Chicago Illinois USA"},{"name":"Division of Thoracic Surgery, Department of Surgery Universit\u00e9 de Montr\u00e9al  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1570-6474","authenticated-orcid":false,"given":"Muhammed M.","family":"Alikhan","sequence":"additional","affiliation":[{"name":"Kenneth C. Griffin Esophageal Center of Northwestern Medicine, Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine Northwestern University  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0665-3454","authenticated-orcid":false,"given":"Neelesh A.","family":"Patankar","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, McCormick School of Engineering Northwestern University  Evanston Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1702-7758","authenticated-orcid":false,"given":"Dustin A.","family":"Carlson","sequence":"additional","affiliation":[{"name":"Kenneth C. Griffin Esophageal Center of Northwestern Medicine, Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine Northwestern University  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"crossref","DOI":"10.1111\/nmo.14058","article-title":"Esophageal Motility Disorders on High\u2010Resolution Manometry: Chicago Classification Version 4.0((c))","volume":"33","author":"Yadlapati R.","year":"2021","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_9_3_1","doi-asserted-by":"crossref","DOI":"10.1111\/nmo.14193","article-title":"Esophagogastric Junction Outflow Obstruction","volume":"33","author":"Bredenoord A. J.","year":"2021","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"1310","DOI":"10.1111\/nmo.12625","article-title":"Characterization of Idiopathic Esophagogastric Junction Outflow Obstruction","volume":"27","author":"Hoeij F. B.","year":"2015","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/nmo.13105","article-title":"The Clinical Significance of Esophagogastric Junction Outflow Obstruction and Hypercontractile Esophagus in High Resolution Esophageal Manometry","volume":"29","author":"Schupack D.","year":"2017","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_9_6_1","doi-asserted-by":"crossref","first-page":"77","DOI":"10.14309\/ajg.0000000000001980","article-title":"FLIP Panometry Helps Identify Clinically Relevant Esophagogastric Junction Outflow Obstruction Per Chicago Classification v4.0","volume":"118","author":"Carlson D. A.","year":"2023","journal-title":"American Journal of Gastroenterology"},{"key":"e_1_2_9_7_1","doi-asserted-by":"crossref","DOI":"10.1177\/1756284820969050","article-title":"Four\u2010Dimensional Impedance Manometry Derived From Esophageal High\u2010Resolution Impedance\u2010Manometry Studies: A Novel Analysis Paradigm","volume":"13","author":"Kou W.","year":"2020","journal-title":"Therapeutic Advances in Gastroenterology"},{"key":"e_1_2_9_8_1","doi-asserted-by":"crossref","DOI":"10.1111\/nmo.14423","article-title":"Normative Values of Intra\u2010Bolus Pressure and Esophageal Compliance Based on 4D High\u2010Resolution Impedance Manometry","volume":"34","author":"Kou W.","year":"2022","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_9_9_1","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.14309\/ajg.0000000000003151","article-title":"Four\u2010Dimensional Impedance Manometry in Esophageal Motility Disorders","volume":"120","author":"Goudie E.","year":"2025","journal-title":"American Journal of Gastroenterology"},{"key":"e_1_2_9_10_1","doi-asserted-by":"crossref","first-page":"347","DOI":"10.5056\/jnm24170","article-title":"Assessing Treatment Outcomes in Achalasia Using 4\u2010Dimensional High\u2010Resolution Impedance Manometry","volume":"31","author":"Li M.","year":"2025","journal-title":"Journal of Neurogastroenterology and Motility"},{"key":"e_1_2_9_11_1","doi-asserted-by":"crossref","first-page":"2357","DOI":"10.14309\/ajg.0000000000001532","article-title":"Classifying Esophageal Motility by FLIP Panometry: A Study of 722 Subjects With Manometry","volume":"116","author":"Carlson D. A.","year":"2021","journal-title":"American Journal of Gastroenterology"},{"key":"e_1_2_9_12_1","doi-asserted-by":"crossref","first-page":"G437","DOI":"10.1152\/ajpgi.00148.2014","article-title":"The Four Phases of Esophageal Bolus Transit Defined by High\u2010Resolution Impedance Manometry and Fluoroscopy","volume":"307","author":"Lin Z.","year":"2014","journal-title":"American Journal of Physiology. Gastrointestinal and Liver Physiology"},{"issue":"6","key":"e_1_2_9_13_1","doi-asserted-by":"crossref","DOI":"10.1053\/j.gastro.2025.01.234","article-title":"A Standardized Approach to Performing and Interpreting FLIP Panometry for Esophageal Motility Disorders: The Dallas Consensus","volume":"168","author":"Carlson D. A.","year":"2025","journal-title":"Gastroenterology"},{"key":"e_1_2_9_14_1","doi-asserted-by":"crossref","first-page":"e1250","DOI":"10.1016\/j.cgh.2021.06.040","article-title":"Validation of Clinically Relevant Thresholds of Esophagogastric Junction Obstruction Using FLIP Panometry","volume":"20","author":"Carlson D. A.","year":"2022","journal-title":"Clinical Gastroenterology and Hepatology"},{"key":"e_1_2_9_15_1","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1053\/j.gastro.2025.02.013","article-title":"Diagnostic Accuracy of Timed Barium Esophagram for Achalasia","volume":"169","author":"Fass O. Z.","year":"2025","journal-title":"Gastroenterology"},{"key":"e_1_2_9_16_1","doi-asserted-by":"crossref","DOI":"10.1111\/nmo.14116","article-title":"Evaluating Esophageal Motility Beyond Primary Peristalsis: Assessing Esophagogastric Junction Opening Mechanics and Secondary Peristalsis in Patients With Normal Manometry","volume":"33","author":"Carlson D. 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