Skip to main content
SpringerLink
Log in

Functional Lumen Imaging Probe to Assess Geometric Changes in the Esophagogastric Junction Following Endolumenal Fundoplication

  • 2010 SSAT Quick Shot Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The functional lumen imaging probe (FLIP) uses impedance planimetry to measure the geometry of a distensible organ. The purpose of this study was to evaluate FLIP as a method to determine structural changes at the gastroesophageal junction (GEJ) following transoral incisionless fundoplication (TIF) and compare these findings with the accepted methods of esophageal testing.

Methods

Two different approaches (TIF1.0 and 2.0) using the EsophyX™ device were performed in six and five animals, respectively. Three dogs underwent a sham procedure. FLIP measurements were performed pre- and post-procedure and at 2-week follow-up. Upper endoscopy, manometry, and 48-h pH testing were also performed at each time point. FLIP was performed in ten patients before and 3 months after TIF.

Results

Following TIF procedures, there was a significant decrease in cross-sectional area (CSA) of GEJ compared to baseline; however, the CSA of both groups returned to baseline at 2-week follow-up. The FLIP results were supported with pH testing and correlated highly with both measures of GEJ structural integrity (LES and cardia circumference). Following TIF in humans, there was a decrease in GEJ distensibility compared to baseline that persisted to the 3-month evaluation.

Conclusion

FLIP is able to measure and display changes in tissue distensibility at the GEJ, and results correlate with established methods of testing. FLIP may represent a single testing modality by which to diagnose GERD and evaluate the outcome after antireflux surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. McMahon BP, Frokjaer JB, Kunwald P, et al. The functional lumen imaging probe (FLIP) for evaluation of the esophagogastric junction. Am J Physiol Gastrointest Liver Physiol. 2007;292(1):G377-84.

    Article  PubMed  CAS  Google Scholar 

  2. Cadiere GB, Rajan A, Rqibate M, et al. Endoluminal fundoplication (ELF)--evolution of EsophyX, a new surgical device for transoral surgery. Minim Invasive Ther Allied Technol. 2006;15(6):348–55.

    Article  PubMed  CAS  Google Scholar 

  3. Harris LD, Pope CE, 2nd. "Squeeze" Vs. Resistance: An Evaluation of the Mechanism of Sphincter Competence. J Clin Invest. 1964;43:2272–8.

    Article  PubMed  CAS  Google Scholar 

  4. Jobe BA, O'Rourke RW, McMahon BP, Gravesen F, Lorenzo C, Hunter GJ, Bronner M, Kraemer JMS. Transoral endoscopic fundoplication in the treatment of gastroesophageal reflux disease: the anatomic and physiologic basis for reconstruction of the esophagogastric junction using a novel device. Ann Surg. 2008;248(1):69–76.

    Article  PubMed  Google Scholar 

  5. Cadiere GB, Buset M, Muls V, et al (2008) Antireflux Transoral Incisionless Fundoplication Using EsophyX: 12-Month Results of a Prospective Multicenter Study. World J Surg 32(8):1676–1688.

    Article  PubMed  Google Scholar 

  6. Hollenbeck JI, Maher JW, Wickbom G, Bushkin FL, McGuigan JE, Woodward ER. The effect of feeding on the canine lower esophageal sphincter. Journal of Surgical Research. 1975;18(5):497–9.

    Article  PubMed  CAS  Google Scholar 

  7. Watrous BJ, Suter PF. Normal Swallowing on the Dog: A Cineradiographic Study. Veterinary Radiology and Ultrasound. 1979;20(3–6):99–109.

    Google Scholar 

  8. McMahon RL, Ali A, Chekan EG, et al. A canine model of gastroesophageal reflux disease (GERD). Surg Endosc. 2002;16(1):67–74.

    Article  PubMed  CAS  Google Scholar 

  9. Jobe BA, Kahrilas PJ, Vernon AH, et al. Endoscopic appraisal of the gastroesophageal valve after antireflux surgery. Am J Gastroenterol. 2004;99:233–243.

    Article  PubMed  Google Scholar 

  10. Hill LD, Kozarek RA, Kraemer SJM, et al. The gastroesophageal flap valve: in vitro and in vivo observations. Gastrointest Endosc. 1996;44:541–547.

    Article  PubMed  CAS  Google Scholar 

  11. Seltman AK, Kahrilas PJ, Chang EY, et al. Endoscopic measurement of cardia circumference as an indicator of GERD. Gastrointest Endosc 2006;63:22–31.

    Article  PubMed  Google Scholar 

  12. Kwiateck MA, Pandolfino JE, Hirano I, Kahrilas PJ (2010) Esophagogastric junction distensibility assessed with an endoscopic functional lumen imaging probe (EndoFLIP). Gastrointest Endosc 72:272–8.

    Article  Google Scholar 

  13. Jobe BA, Kahrilas PJ, Vermon AH, et al (2004) Endoscopic appraisal of the gastroesophageal valve after antireflux surgery. Am J Gastroenterol 99(2):233–43.

    Article  PubMed  Google Scholar 

  14. Jacob BP, Dakin G, Divino D, et al. Long-term follow-up evaluation for a canine model of gastroesophageal reflux disease. Surg Endosc 2003;17:354.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Shadyside Medical Center, Suite 715, 5200 Centre Avenue, Pittsburgh, PA, 15232, USA

    Toshitaka Hoppo, Bart P. L. Witteman & Blair A. Jobe

  2. Department of Medical Physics & Clinical Engineering, Adelaide & Meath Hospital, Dublin, Ireland

    Barry P. McMahon

  3. EndoGastric Solutions, Inc., Redmond, WA, USA

    Stefan J. M. Kraemer

  4. Department of Surgery, Oregon Health & Science University, Portland, OR, USA

    Robert W. O’Rourke

  5. Mech-Sense, Aalborg Hospital, Aalborg, Denmark

    Flemming Gravesen

  6. Department of Surgery, University Hospital, Maastricht, The Netherlands

    Nicole D. Bouvy

Authors
  1. Toshitaka Hoppo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Barry P. McMahon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bart P. L. Witteman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefan J. M. Kraemer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Robert W. O’Rourke
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Flemming Gravesen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nicole D. Bouvy
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Blair A. Jobe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Blair A. Jobe.

Additional information

This paper was presented at the 51st annual meeting of The Society for Surgery of Alimentary Tract, May 4, 2010, New Orleans, Louisiana.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hoppo, T., McMahon, B.P., Witteman, B.P.L. et al. Functional Lumen Imaging Probe to Assess Geometric Changes in the Esophagogastric Junction Following Endolumenal Fundoplication. J Gastrointest Surg 15, 1112–1120 (2011). https://doi.org/10.1007/s11605-011-1562-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-011-1562-2

Keywords

Search

Navigation