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FLIP in Clinical Practice: When Is It Helpful?

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Abstract

Purpose of Review

Functional lumen imaging probe (FLIP) Panometry is as an important tool in the diagnosis and management of esophageal disorders.

Recent Findings

Using high-resolution impedance planimetry, FLIP assesses esophagogastric junction (EGJ) and esophageal body distensibility as well as the contractile response to distension (secondary peristalsis) at the time of sedated endoscopy. These features can be incorporated to classify esophageal motility, which often parallels high-resolution manometry (HRM) and the Chicago Classification (CCv4.0). The role of FLIP Panometry has been evaluated in multiple clinical scenarios, such as clarifying inconclusive HRM, excluding primary esophageal motility disorders, and guiding management for esophageal diseases.

Summary

FLIP Panometry has proven to be a diagnostic tool that can complement, or in some cases be an alternative to, HRM in the evaluation of esophageal dysmotility. The strongest recommended benefit of FLIP in current clinical practice is with clarifying equivocal HRM, such as EGJOO or inconclusive achalasia. There are also promising results demonstrating the role for FLIP in excluding primary motility disorders during an initial endoscopy, as well as for the use of FLIP for evaluating treatment and outcomes in achalasia, gastroesophageal reflux disease (GERD), and eosinophilic esophagitis (EoE). With continued expanding use of FLIP across multiple centers and clinical scenarios, additional evolution of the role for FLIP is anticipated as well.

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Data Availability

No datasets were generated or analyzed during the current study.

References and Recommended Reading

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

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  1. Department of Medicine, Division of Gastroenterology and Hepatology, Kenneth C. Griffin Esophageal Center of Northwestern Medicine, Feinberg School of Medicine, Northwestern University, 676 St Clair St, Suite 1400, Chicago, IL, 60611-2951, USA

    Elena C. Pezzino MD, Daniel R. Arndorfer MD & Dustin A. Carlson MD, MSCI

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All authors (ECP, DRA, DAC) wrote the main manuscript text, prepared figures, and reviewed the manuscript.

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Correspondence to Dustin A. Carlson MD, MSCI.

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Dustin A. Carlson: Medtronic (Speaking, Consulting, License); Phathom Pharmaceuticals (Consulting); Braintree (Consulting); Medpace (Consulting).

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Pezzino, E.C., Arndorfer, D.R. & Carlson, D.A. FLIP in Clinical Practice: When Is It Helpful?. Curr Treat Options Gastro (2024). https://doi.org/10.1007/s11938-024-00442-8

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  • DOI: https://doi.org/10.1007/s11938-024-00442-8

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