Interactive Panometry: Using Proximal Balloon Distension During Functional Lumen Imaging Probe Panometry to Enhance Motility Evaluation of Inhibitory Function
- 1Kenneth C. Griffin Esophageal Center of Northwestern Medicine, Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University Chicago IL USA
Abstract
Background/Aims: Descending inhibition facilitates esophageal peristalsis and lower esophageal sphincter relaxation, processes impaired in achalasia. The functional lumen imaging probe (FLIP) assesses esophageal motility and esophagogastric junction (EGJ) opening but does not directly evaluate neuromyogenic function. We developed “Interactive Panometry,” a novel FLIP maneuver utilizing proximal balloon distension to physiologically provoke descending inhibition.
Methods: Four healthy volunteers and 5 patients with untreated type II achalasia underwent FLIP Panometry with proximal esophageal balloon distension (20-mm in controls, 20–30 mm in achalasia) at 50-mL and 60-mL fill volumes. EGJ distensibility index (EGJ-DI), intra-bag pressure, and contractile response were measured before, during, and after distension. In 3 controls, simultaneous high-resolution manometry was performed to verify physiologic responses.
Results: Feasibility was first demonstrated in control subjects using simultaneous FLIP and high-resolution manometry. Proximal balloon distension induced cessation of repetitive antegrade contractions with concurrent increases in EGJ-DI and reductions in FLIP pressure. At a 50-mL FLIP fill volume and 20-mm proximal balloon distension, controls demonstrated a mean EGJ-DI increase of 3.5 mm²/mm Hg and a 16.5-mm Hg pressure reduction, whereas achalasia cases exhibited an EGJ-DI increase of 0.1 mm²/mm Hg and a 0.2 mmHg pressure reduction. With 30-mm proximal distension, achalasia cases showed an EGJ-DI increase of 0.2 mm²/mm Hg and a 5.3-mm Hg pressure reduction. Trends were similar at 60-mL fill volumes.
Conclusions: Interactive Panometry is a feasible FLIP maneuver physiologically consistent with descending inhibition. This proof-of-concept study supports further investigation in larger cohorts of symptomatic patients with suspected esophageal dysmotility to validate its role in assessing descending inhibition.
Related
- Evaluation of Therapeutic Drug Monitoring for Vancomycin with Ratio of Area Under the Curve to Minimum Inhibitory Concentration at a Children’s and Women’s Tertiary Hospital
- French validation of the short version of the ASA questionnaire: An exploration of the socio-technical imaginaries and cosmology of Socially Interactive Agent evaluation
- Comparative Evaluation of Tyrosinase Inhibitory Activity in Taxonomically Verified Wood-Inhabiting Fungi
- Comparative evaluation of the nutritional composition, antioxidant capacity and inhibitory activities against α-amylase and α-glucosidase of three Nigerian leafy vegetables (Amaranthus hybridus L., Celosia argentea L. and Solanum macrocarpon L.).
- A nurse-led standardized bedside gastric ultrasound monitoring protocol for abdominal distension management in critically ill patients receiving enteral nutrition: a pragmatic, exploratory randomized controlled trial.
BibTeX
@article{fass2026interactive,
title = {{Interactive Panometry: Using Proximal Balloon Distension During Functional Lumen Imaging Probe Panometry to Enhance Motility Evaluation of Inhibitory Function}},
author = {Ofer Z. Fass and Muhammed M. Alikhan and John E. Pandolfino and Meagan Branch and Monica Tapia and Leya Chambo and Peter J. Kahrilas and Dustin A. Carlson},
journal = {Journal of Neurogastroenterology and Motility},
year = {2026},
month = oct,
doi = {10.5056/jnm25245},
url = {https://doi.org/10.5056/jnm25245},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Interactive Panometry: Using Proximal Balloon Distension During Functional Lumen Imaging Probe Panometry to Enhance Motility Evaluation of Inhibitory Function
AU - Ofer Z. Fass
AU - Muhammed M. Alikhan
AU - John E. Pandolfino
AU - Meagan Branch
AU - Monica Tapia
AU - Leya Chambo
AU - Peter J. Kahrilas
AU - Dustin A. Carlson
PY - 2026
DA - 2026/10/31
JO - Journal of Neurogastroenterology and Motility
DO - 10.5056/jnm25245
UR - https://doi.org/10.5056/jnm25245
AB - Background/Aims: Descending inhibition facilitates esophageal peristalsis and lower esophageal sphincter relaxation, processes impaired in achalasia. The functional lumen imaging probe (FLIP) assesses esophageal motility and esophagogastric junction (EGJ) opening but does not directly evaluate neuromyogenic function. We developed “Interactive Panometry,” a novel FLIP maneuver utilizing proximal balloon distension to physiologically provoke descending inhibition. Methods: Four healthy volunteers and 5 patients with untreated type II achalasia underwent FLIP Panometry with proximal esophageal balloon distension (20-mm in controls, 20–30 mm in achalasia) at 50-mL and 60-mL fill volumes. EGJ distensibility index (EGJ-DI), intra-bag pressure, and contractile response were measured before, during, and after distension. In 3 controls, simultaneous high-resolution manometry was performed to verify physiologic responses. Results: Feasibility was first demonstrated in control subjects using simultaneous FLIP and high-resolution manometry. Proximal balloon distension induced cessation of repetitive antegrade contractions with concurrent increases in EGJ-DI and reductions in FLIP pressure. At a 50-mL FLIP fill volume and 20-mm proximal balloon distension, controls demonstrated a mean EGJ-DI increase of 3.5 mm²/mm Hg and a 16.5-mm Hg pressure reduction, whereas achalasia cases exhibited an EGJ-DI increase of 0.1 mm²/mm Hg and a 0.2 mmHg pressure reduction. With 30-mm proximal distension, achalasia cases showed an EGJ-DI increase of 0.2 mm²/mm Hg and a 5.3-mm Hg pressure reduction. Trends were similar at 60-mL fill volumes. Conclusions: Interactive Panometry is a feasible FLIP maneuver physiologically consistent with descending inhibition. This proof-of-concept study supports further investigation in larger cohorts of symptomatic patients with suspected esophageal dysmotility to validate its role in assessing descending inhibition.
SN - 2093-0879
SN - 2093-0887
ER -