EsoFLIP-assisted dilation for dysphagia in systemic sclerosis: Highlighting the role of multimodal esophageal evaluation

Scleroderma is an autoimmune disorder characterized by vasculopathy, progressive skin fibrosis, and dysfunction of internal organs. Esophageal involvement is seen in most scleroderma patients. There is no specific treatment for dysphagia caused by scleroderma. FLIP technology is a novel diagnostic and therapeutic modality to assess the tightness of esophageal sphincters and esophageal motility and also provide therapeutic dilation. We describe the case of a patient with scleroderma who presented with dysphagia. Upper endoscopy was unremarkable. Esophageal manometry revealed aperistalsis with normal upper and lower esophageal sphincter (LES) relaxation. Barium esophagram demonstrated poor esophageal motility and hold-up of the barium tablet at the gastroesophageal junction. EndoFLIP test during sedated upper endoscopy revealed normal LES distensibility and absent peristalsis of the esophageal body. Due to dysphagia, the LES was dilated with a 30 mm EsoFLIP. A barium esophagram following the dilation revealed a significant reduction in esophageal body diameter, normalization of barium tablet transit, and symptomatic improvement in dysphagia. Our case is the first report of the use of EsoFLIP to help improve dysphagia in a scleroderma patient. It illustrates the importance of multi-modal functional testing in patients with dysphagia and suggests the utility of EsoFLIP in the treatment of dysphagia in these patients.