Devices for esophageal function testing

Abstract

Background and Aims Esophageal function testing is an integral component of the evaluation of refractory GERD and esophageal motility disorders. This review summarizes the current technologies available for esophageal function testing, including the functional luminal imaging probe (FLIP), high-resolution esophageal manometry (HRM), and multichannel intraluminal impedance (MII) and pH monitoring. Methods We performed a MEDLINE, PubMed, and MAUDE database literature search to identify pertinent clinical studies through March 2021 using the following key words: esophageal manometry, HRM, esophageal impedance, FLIP, MII, and esophageal pH testing. Technical data were gathered from traditional and web-based publications, proprietary publications, and informal communications with pertinent vendors. The report was drafted, reviewed, and edited by the American Society for Gastrointestinal Endoscopy Technology Committee and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy. Results FLIP is a high-resolution impedance planimetry system used for pressure and dimension measurement in the esophagus, pylorus, and anal sphincter. FLIP provides complementary information to HRM for esophageal motility disorders, especially achalasia. The Chicago classification, based on HRM data, is a widely adopted algorithmic scheme used to diagnose esophageal motility disorders. MII detects intraluminal bolus movement and, combined with pH measurement or manometry, provides information on acid and non-acid gastroesophageal reflux and bolus transit in patients with refractory GERD and for preoperative evaluation for anti-reflux procedures. Conclusions Esophageal function testing techniques (FLIP, HRM, and MII-pH) have diagnostic and prognostic value in the evaluation of esophageal motility disorders and refractory GERD. Newer technologies and classification systems have enabled an increased understanding of these diseases.

Peroral Endoscopic Myotomy

“…A 15-study meta-analysis was conducted to assess the comparative efficacy of POEM and HM (Park et al, 2019). The study evaluated the Eckardt scores, perioperative outcomes, and reflux-related outcomes of 1,213 patients (Park et al, 2019).…”

“…A 15-study meta-analysis was conducted to assess the comparative efficacy of POEM and HM (Park et al, 2019). The study evaluated the Eckardt scores, perioperative outcomes, and reflux-related outcomes of 1,213 patients (Park et al, 2019). Eckardt scoring is a grading system most commonly used to analyze symptoms, stages, and efficacy of achalasia treatment (Laurino-Neto, Herbella, Schlottmann, & Patti, 2018).…”

“…It assigns points (0–3 points) for four symptoms of the disease: dysphagia, regurgitation, chest pain, and weight loss (Table 1) (Laurino-Neto et al, 2018). The follow-up duration was from 2 to 46.2 months in the POEM group and from 2 to 54.2 months in the HM groups (Park et al, 2019). The POEM group yielded better (lower) Eckardt scores than the HM group (pooled standardized mean difference, −0.58; 95% confidence interval [CI], −1.03 to −0.13) (Park et al, 2019).…”

“…additional novel treatment includes therapeutic application of a hydrostatic dilation balloon (3-30 mm as indicated for achalasia), using high-resolution impedance planimetry with an esophageal functional luminal imaging probe called EsoFLIP (Medtronic Inc, Shoreview, Minnesota) (Brindise et al, 2021). The EsoFLIP is conducted concomitant EGD by advancing a catheter into the esophagus transorally and positioned as volume-controlled distention of the balloon occurs incrementally while visualizing a real-time three-dimensional monitor (Pannala et al, 2022).…”

Perspective Chapter: Update on Achalasia Treatment

“…It uses high-resolution impedance planimetry during volume-controlled distension of the probe once it passes the EGJ. Specifically, EndoFLIP analyzes the relationship between luminal cross-sectional area (CSA) and pressure, providing a measurement of the luminal distensibility (CSA/ pressure) [21,22]. The EndoFLIP can be used intraoperatively to assess treatment results following completion of myotomy (Figure 4).…”