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Use of the Functional Lumen Imaging Probe in Clinical Esophagology.

Authors :
Savarino E
di Pietro M
Bredenoord AJ
Carlson DA
Clarke JO
Khan A
Vela MF
Yadlapati R
Pohl D
Pandolfino JE
Roman S
Gyawali CP
Source :
The American journal of gastroenterology [Am J Gastroenterol] 2020 Nov; Vol. 115 (11), pp. 1786-1796.
Publication Year :
2020

Abstract

The functional lumen imaging probe (FLIP) measures luminal dimensions using impedance planimetry, performed most often during sedated upper endoscopy. Mechanical properties of the esophageal wall and opening dynamics of the esophagogastric junction (EGJ) can be objectively evaluated in esophageal motor disorders, eosinophilic esophagitis, esophageal strictures, during esophageal surgery and in postsurgical symptomatic states. Distensibility index, the ratio of EGJ cross sectional area to intraballoon pressure, is the most useful FLIP metric. Secondary peristalsis from balloon distension can be displayed topographically as repetitive anterograde or retrograde contractile activity in the esophageal body, similar to high-resolution manometry. Real-time interpretation and postprocessing of FLIP metadata can complement the identification of esophageal outflow obstruction and achalasia, especially when findings are inconclusive from alternate esophageal tests in symptomatic patients. FLIP can complement the diagnosis of achalasia when manometry and barium studies are inconclusive or negative in patients with typical symptoms. FLIP can direct adequacy of disruption of the EGJ in achalasia when used during and immediately after myotomy and pneumatic dilation. Lumen diameter measured using FLIP in eosinophilic esophagitis and in complex strictures can potentially guide management. An abbreviated modification of the Grading of Recommendations Assessment, Development, and Evaluation was used to determine the quality of available evidence and recommendations regarding FLIP utilization. FLIP metrics that are diagnostic or suggestive of an abnormal motor pattern and metrics that define normal esophageal physiology were developed by consensus and are described in this review.

Details

Language :
English
ISSN :
1572-0241
Volume :
115
Issue :
11
Database :
MEDLINE
Journal :
The American journal of gastroenterology
Publication Type :
Academic Journal
Accession number :
33156096
Full Text :
https://doi.org/10.14309/ajg.0000000000000773