Pediatric vascular compression of the esophagus: Endoluminal functional lumen imaging probe as a complement to imaging and endoscopy

Abstract Objectives Vascular anomalies can cause extrinsic esophageal compression, leading to dysphagia or feeding difficulties in children. Diagnosis typically relies on imaging and endoscopy, which may under‐ or overestimate functional narrowing. Endoluminal functional lumen imaging probe (EndoFLIP) provides luminal parameters in real‐time, but its role in vascular compression is not well‐defined. Methods We retrospectively reviewed children with vascular anomalies who underwent upper endoscopy with EndoFLIP (July 2021–April 2025). Demographics, imaging, endoscopic/EndoFLIP findings, and outcomes were recorded. In select cases, paired measurements at the lower esophageal sphincter (LES) and compression site were compared at matched balloon volumes. Results Eight patients (mean age 12.1 years; range 6–17; 5 females) were included. Vascular anomalies included left aortic arch with aberrant right subclavian artery ( n = 5), double aortic arch ( n = 2), and right aortic arch with anomalous left subclavian artery ( n = 1). EndoFLIP detected narrowing in 6/8 (75%), compared with 4/8 (50%) on endoscopy and 6/7 (86%) on upper gastrointestinal (UGI) series. Two patients had narrowing on EndoFLIP despite normal endoscopy; two others had UGI narrowing but normal EndoFLIP and endoscopy. Paired measurements ( n = 2) showed markedly reduced diameter and distensibility at the compression site versus the LES. Management included surgical repair ( n = 3), dietary modification ( n = 2), and proton‐pump inhibitor therapy ( n = 3), with variable symptom improvement. No procedural complications occurred. Conclusions EndoFLIP was safe, feasible, and provided meaningful complementary physiologic information in this heterogeneous cohort. These preliminary findings support a potential diagnostic role for EndoFLIP in esophageal vascular compression, warranting confirmation in larger, standardized, prospective studies.