Emerging Roles of the Endolumenal Functional Lumen Imaging Probe in Gastrointestinal Motility Disorders

Abstract

Gastrointestinal sphincters play a vital role in gut function and motility by separating the gut into functional segments. Traditionally, function of sphincters including the esophagogastric junction is studied using endoscopy and manometry. However, due to its dynamic biomechanical properties, data on distensibility and compliance may provide a more accurate representation of the sphincter function. The endolumenal functional lumen imaging probe (EndoFLIP) system uses a multi-detector impedance planimetry system to provide data on tissue distensibility and geometric changes in the sphincter as measured through resistance to volumetric distention with real-time images. With the advent of EndoFLIP studies, esophagogastric junction dysfunction and other disorders of the stomach and bowels may be better evaluated. It may be utilized as a tool in predicting effectiveness of endoscopic and surgical treatments as well as patient outcomes.

Functional lumen imaging probe in gastrointestinal motility diseases

“…Intraoperative distensibility measurement using FLIP was first reported by Perretta et al Subsequent studies further confirmed that the CSA of the EGJ and the LES‐DI significantly increased after a Heller myotomy or POEM . Measuring distensibility with FLIP intraoperatively offers the possibility to assess the efficacy of LES myotomy in real time, which potentially predicts a patient's clinical response to therapy . Ata‐Lawenko et al proposed that a cut‐off value of distensibility ≤1 mm 2 /mmHg and that of a diameter ≤5 mm indicated a need for dilatation, myotomy or POEM .…”

“…Gourcerol et al found that fasting pyloric compliance decreased in a subgroup of patients with gastroparesis, and dilatation in these individuals improved their quality of life scores . Ata‐Lawenko et al proposed that the cut‐off value of distensibility for intervention should be <10 mm 2 /mmHg …”

“…[16][17][18][19][20][21] Measuring distensibility with FLIP intraoperatively offers the possibility to assess the efficacy of LES myotomy in real time, which potentially predicts a patient's clinical response to therapy. 2,22,23 Ata-Lawenko et al proposed that a cut-off value of distensibility ≤1 mm 2 /mmHg and that of a diameter ≤5 mm indicated a need for dilatation, myotomy or POEM. 22 Additionally, distensibility of the EGJ appears to improve after a pneumatic dilatation.…”

“…2,22,23 Ata-Lawenko et al proposed that a cut-off value of distensibility ≤1 mm 2 /mmHg and that of a diameter ≤5 mm indicated a need for dilatation, myotomy or POEM. 22 Additionally, distensibility of the EGJ appears to improve after a pneumatic dilatation. However, response to a successful treatment may require an even higher post-dilatation distensibility in this cluster of patients than that measured in healthy participants because of incompetent motility.…”

“…Gourcerol et al found that fasting pyloric compliance decreased in a subgroup of patients with gastroparesis, and dilatation in these individuals improved their quality of life scores. 40 Ata-Lawenko et al proposed that the cut-off value of distensibility forintervention should be <10 mm 2 /mmHg 22. Jacques et al used EndoFLIP in a retrospective study including 20 patients to evaluate pyloric DI after endoscopic intervention.…”