Eosinophilic Esophagitis, Esophageal Stricture, Schatzki Ring, Zenkers Diverticulum
Conditions
Keywords
esophagus, upper GI, endoscopy, endoFLIP, functional luminal imaging, esophageal stricture, narrow esophagus, narrow caliber esophagus, esophageal narrowing, eosinophilic esophagitis, Zenkers diverticulum, Schatzki ring
Brief summary
The purpose of this study is to investigate the use of a functional luminal imaging probe to characterize benign esophageal luminal strictures before and after dilation and identify predictors of response to therapy. Patients will be evaluated during endoscopy using functional luminal imaging (EndoFLIP; Crospon Medical Devices, Galway, Ireland) to characterize the geometry of benign luminal esophageal narrowing before and after dilation.
Detailed description
To date there is no effective way to objectively characterize and predict response to endoscopic dilation of luminal strictures of the GI tract. Endoscopic dilation allows effective remediation of benign esophageal and upper GI tract strictures. Stricture dilation is performed after the stricture diameter is crudely gauged by the endoscopist. Stricture characteristics are based on the severity of symptoms and appearance. A stricture may be graded as mild, moderate, severe and as to whether or not the endoscope is able to traverse the luminal narrowing. By precisely measuring the diameter and length of a stricture, the endoscopist can know exactly what type of dilation is necessary. Benign esophageal strictures may also be refractory to dilation and thus require multiple sessions, prior to achieving successful remediation. The purpose of this study is to investigate the use of a functional luminal imaging probe to characterize benign esophageal luminal strictures before and after dilation and identify predictors of response to therapy. Patients will be evaluated during endoscopy using functional luminal imaging (EndoFLIP; Crospon Medical Devices, Galway, Ireland) to characterize the geometry of benign luminal esophageal narrowing before and after dilation. The study will include patients with strictures referred for endoscopic dilation for the following indications: radiation induced strictures, peptic strictures, RFA induced strictures, EMR induced strictures, eosinophilic esophagitis, Zenkers diverticulum, and strictures related to surgical anastomoses. In patients with benign refractory esophageal strictures referred for endoluminal prostheses EndoFLIP will be used to characterize the stricture prior to stent placement.
Interventions
DEVICEEndoFLIP
The Endolumenal Functional Lumenal Imaging Probe Imaging System is a technology developed to measure the dimensions & function of a variety of hollow organs throughout the body. Since receiving FDA clearance for sale in the United States EndoFLIP has been used in a variety of clinical applications. We intend to investigate the potential clinical applications of EndoFLIP in the upper GI tract in patients with esophageal stenoses who require endoscopic therapy for benign esophageal strictures. The use of EndoFLIP to characterize a stricture pre- & post- dilation may offer insight in to the clinical and endoscopic predictors of successful stricture dilation, & what characteristics determine & predict refractory & recurrent strictures.
Sponsors
University of Pennsylvania
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* \> or = to 18 years of age * Referred for evaluation and treatment of benign esophageal luminal narrowing * Clinical diagnosis of benign esophageal luminal narrowing with documentation and imaging * Adult patients with benign refractory esophageal strictures referred for placement of an esophageal stent are eligible for this study * Willing and able to give informed consent * No condition or comorbidity which would prevent the patient from undergoing a successful upper endoscopy
Exclusion criteria
* \< 18 years of age * Pregnancy * History of prior endoscopic dilation\* (\*unless referred for placement of stent) * Coagulopathy * Inability to traverse the stricture using standard techniques * Patients unable to provide consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Collection of Measurements of the Luminal Narrowing Using EndoFlip | 12 Months | The study is observational and a proof of concept study. Measurements of the luminal narrowing using EndoFLIP will be obtained. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Observation of Pre-Endoscopic Therapy EndoFLIP Measurements | 12 Months | Patients will undergo the clinically indicated procedure for benign esophageal luminal narrowing remediation. Before undergoing clinically indicated esophageal therapy, measurements of the luminal narrowing using EndoFLIP will be obtained to identify potential predictors of response to endoscopic therapy. These measurements will included luminal diameter, length of narrowing and narrowing distensibility and will be obtained before and after delivery of the clinically indicated endoscopic therapy. |
| Observation of Post-Endoscopic Therapy EndoFLIP Measurements | 12 Months | After undergoing clinically indicated esophageal therapy at clinically-indicated follow-up endoscopies, measurements of the luminal narrowing using EndoFLIP will again be obtained to identify responses to endoscopic therapy. |
Countries
United States
Outcome results
None listed