Skip to main content
Log in

Applying the Functional Luminal Imaging Probe to Esophageal Disorders

  • Neurogastroenterology and Motility Disorders of the Gastrointestinal Tract (S Rao, Section Editor)
  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The functional luminal imaging probe (FLIP) uses high-resolution planimetry to provide a three-dimensional image of the esophageal lumen by measuring diameter, volume, and pressure changes. The goal of this review is to summarize the most recent advances in applying the (FLIP) to esophageal disorders.

Recent Findings

The FLIP has been studied in esophageal disease states including gastroesophageal reflux disease (GERD), achalasia, and eosinophilic esophagitis. It has also been used in the investigation of dysphagia.

Summary

The FLIP is a valuable tool for the diagnosis of esophageal diseases as well as guiding treatments and predicting treatment response. As further research is done, the FLIP may become the initial test for the patient with undifferentiated dysphagia at the time of their index endoscopy.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. McMahon BP, Frokjaer JB, Liao D, Kunwald P, Drewes AM, Gregersen H. A new technique for evaluating sphincter function in visceral organs: application of the functional lumen imaging probe (FLIP) for the evaluation of the oesophago-gastric junction. Physiol Meas. 2005;26(5):823–36.

    Article  CAS  Google Scholar 

  2. Carlson DA, Lin Z, Kahrilas PJ, Sternbach J, Donnan EN, Friesen L, et al. The functional lumen imaging probe detects esophageal contractility not observed with manometry in patients with achalasia. Gastroenterology. 2015;149(7):1742–51.

    Article  Google Scholar 

  3. Carlson DA, Lin Z, Rogers MC, Lin CY, Kahrilas PJ, Pandolfino JE. Utilizing functional lumen imaging probe topography to evaluate esophageal contractility during volumetric distention: a pilot study. Neurogastroenterol Motil. 2015;27(7):981–9.

    Article  CAS  Google Scholar 

  4. •• Carlson DA, Kahrilas PJ, Lin Z, Hirano I, Gonsalves N, Listernick Z, et al. Evaluation of esophageal motility utilizing the functional lumen imaging probe. Am J Gastroenterol. 2016;111(12):1726–35 This study evaluated 145 patients with dysphagia with EGD, FLIP, and high-resolution esophageal manometry. FLIP topography identified 95% of patients with abnormal motility on manometry, including 100% of achalasia patients. FLIP topography was able to identify abnormalities not found on manometry.

    Article  Google Scholar 

  5. •• Carlson DA, Kou W, Lin Z, Hinchcliff M, Thakrar A, Falmagne S, et al. Normal values of esophageal distensibility and distension-induced contractility measured by functional luminal imaging probe panometry. Clin Gastroenterol Hepatol. 2019;17(4):674–81 e1 This prospective study evaluated 20 asymptomatic volunteers with the FLIP to identify normal parameters of FLIP panometry. The normal EGJ-DI is greater than 2.8 mm2/mm Hg , distensibility plateau of greater than 18 mm and repetitive antegrade contractions are normal findings for esophageal distensibility and distension-induced contractility.

    Article  Google Scholar 

  6. Ahuja NK, Agnihotri A, Lynch KL, Hoo-Fatt D, Onyimba F, McKnight M, et al. Esophageal distensibility measurement: impact on clinical management and procedure length. Dis Esophagus. 2017;30(8):1–8.

    Article  CAS  Google Scholar 

  7. Carlson DA, Gyawali CP, Kahrilas PJ, Triggs JR, Falmagne S, Prescott J, et al. Esophageal motility classification can be established at the time of endoscopy: a study evaluating real-time functional luminal imaging probe panometry. Gastrointest Endosc. 2019.

  8. •• Hirano I, Pandolfino JE, Boeckxstaens GE. Functional lumen imaging probe for the management of esophageal disorders: expert review from the clinical practice updates committee of the AGA Institute. Clin Gastroenterol Hepatol. 2017;15(3):325–34 This is a clinical practice update that describes the technique of the FLIP as well as reviewing indications in achalasia, EoE and GERD along with best practice advice.

    Article  Google Scholar 

  9. Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, et al. The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27(2):160–74.

    Article  CAS  Google Scholar 

  10. Triggs JR, Carlson DA, Beveridge C, Jain A, Tye MY, Kahrilas PJ, et al. Upright integrated relaxation pressure facilitates characterization of esophagogastric junction outflow obstruction. Clin Gastroenterol Hepatol. 2019.

  11. Pandolfino JE, Shi G, Curry J, Joehl RJ, Brasseur JG, Kahrilas PJ. Esophagogastric junction distensibility: a factor contributing to sphincter incompetence. Am J Physiol Gastrointest Liver Physiol. 2002;282(6):G1052–8.

    Article  CAS  Google Scholar 

  12. Lottrup C, McMahon BP, Ejstrud P, Ostapiuk MA, Funch-Jensen P, Drewes AM. Esophagogastric junction distensibility in hiatus hernia. Dis Esophagus. 2016;29(5):463–71.

    Article  CAS  Google Scholar 

  13. Kwiatek MA, Pandolfino JE, Hirano I, Kahrilas PJ. Esophagogastric junction distensibility assessed with an endoscopic functional luminal imaging probe (EndoFLIP). Gastrointest Endosc. 2010;72(2):272–8.

    Article  Google Scholar 

  14. Kwiatek MA, Kahrilas K, Soper NJ, Bulsiewicz WJ, McMahon BP, Gregersen H, et al. Esophagogastric junction distensibility after fundoplication assessed with a novel functional luminal imaging probe. J Gastrointest Surg. 2010;14(2):268–76.

    Article  Google Scholar 

  15. Tucker E, Sweis R, Anggiansah A, Wong T, Telakis E, Knowles K, et al. Measurement of esophago-gastric junction cross-sectional area and distensibility by an endolumenal functional lumen imaging probe for the diagnosis of gastro-esophageal reflux disease. Neurogastroenterol Motil. 2013;25(11):904–10.

    Article  CAS  Google Scholar 

  16. Carlson DA, Kathpalia P, Craft J, Tye M, Lin Z, Kahrilas PJ, et al. The relationship between esophageal acid exposure and the esophageal response to volumetric distention. Neurogastroenterol Motil. 2018;30(3).

  17. Smeets FG, Keszthelyi D, Bouvy ND, Masclee AA, Conchillo JM. Does measurement of esophagogastric junction distensibility by EndoFLIP predict therapy- responsiveness to endoluminal fundoplication in patients with gastroesophageal reflux disease? J Neurogastroenterol Motil. 2015;21(2):255–64.

    Article  Google Scholar 

  18. Ilczyszyn A, Botha AJ. Feasibility of esophagogastric junction distensibility measurement during Nissen fundoplication. Dis Esophagus. 2014;27(7):637–44.

    Article  CAS  Google Scholar 

  19. Perretta S, Dallemagne B, McMahon B, D’Agostino J, Marescaux J. Video. Improving functional esophageal surgery with a “smart” bougie: Endoflip. Surg Endosc. 2011;25(9):3109.

    Article  Google Scholar 

  20. Ponds FA, Bredenoord AJ, Kessing BF, Smout AJ. Esophagogastric junction distensibility identifies achalasia subgroup with manometrically normal esophagogastric junction relaxation. Neurogastroenterol Motil. 2017;29(1).

  21. Ngamruengphong S, von Rahden BH, Filser J, Tyberg A, Desai A, Sharaiha RZ, et al. Intraoperative measurement of esophagogastric junction cross-sectional area by impedance planimetry correlates with clinical outcomes of peroral endoscopic myotomy for achalasia: a multicenter study. Surg Endosc. 2016;30(7):2886–94.

    Article  Google Scholar 

  22. Campagna RAJ, Carlson DA, Hungness ES, Holmstrom AL, Pandolfino JE, Soper NJ, et al. Intraoperative assessment of esophageal motility using FLIP during myotomy for achalasia. Surg Endosc. 2019.

  23. • Wu PI, Szczesniak MM, Craig PI, Choo L, Engelman J, Terkasher B, et al. Novel intra-procedural distensibility measurement accurately predicts immediate outcome of pneumatic dilatation for idiopathic achalasia. Am J Gastroenterol. 2018;113(2):205–12 This prospective study evaluated 54 patients with achalasia undergoing pneumatic dilation. Using the FLIP the EGJ-DI was measured immediately pre- and post-pneumatic dilation. The change in EGJ-DI was found to be highly predictive of immediate clinical response.

    Article  CAS  Google Scholar 

  24. Kappelle WF, Bogte A, Siersema PD. Hydraulic dilation with a shape-measuring balloon in idiopathic achalasia: a feasibility study. Endoscopy. 2015;47(11):1028–34.

    Article  Google Scholar 

  25. Jain AS, Carlson DA, Triggs J, Tye M, Kou W, Campagna R, et al. Esophagogastric junction distensibility on functional lumen imaging probe topography predicts treatment response in achalasia-anatomy matters! Am J Gastroenterol. 2019.

  26. Dellon ES, Gonsalves N, Hirano I, Furuta GT, Liacouras CA, Katzka DA, et al. ACG clinical guideline: evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J Gastroenterol. 2013;108(5):679–92 quiz 93.

    Article  Google Scholar 

  27. Gentile N, Katzka D, Ravi K, Trenkner S, Enders F, Killian J, et al. Oesophageal narrowing is common and frequently under-appreciated at endoscopy in patients with oesophageal eosinophilia. Aliment Pharmacol Ther. 2014;40(11–12):1333–40.

    Article  CAS  Google Scholar 

  28. Kwiatek MA, Hirano I, Kahrilas PJ, Rothe J, Luger D, Pandolfino JE. Mechanical properties of the esophagus in eosinophilic esophagitis. Gastroenterology. 2011;140(1):82–90.

    Article  Google Scholar 

  29. Nicodeme F, Hirano I, Chen J, Robinson K, Lin Z, Xiao Y, et al. Esophageal distensibility as a measure of disease severity in patients with eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2013;11(9):1101–7 e1.

    Article  Google Scholar 

  30. Menard-Katcher C, Benitez AJ, Pan Z, Ahmed FN, Wilkins BJ, Capocelli KE, et al. Influence of age and Eosinophilic esophagitis on esophageal distensibility in a pediatric cohort. Am J Gastroenterol. 2017;112(9):1466–73.

    Article  Google Scholar 

  31. Regan J, Walshe M, Timon C, McMahon BP. Endoflip(R) evaluation of pharyngo-oesophageal segment tone and swallowing in a clinical population: a total laryngectomy case series. Clin Otolaryngol. 2015;40(2):121–9.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Erica N. Donnan.

Ethics declarations

Conflict of Interest

John Pandolfino reports personal fees from Crospon and Medtronic, and has a patent pending, with licensing agreement with Medtryronic through the purchase of Crospon (patent: Panometry- FLIP Topography). Erica Donnan declares no conflict of interest.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, international/national/institutional guidelines).

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Neurogastroenterology and Motility Disorders of the Gastrointestinal Tract

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Donnan, E.N., Pandolfino, J.E. Applying the Functional Luminal Imaging Probe to Esophageal Disorders. Curr Gastroenterol Rep 22, 10 (2020). https://doi.org/10.1007/s11894-020-0749-7

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11894-020-0749-7

Keywords

Navigation