Functional Luminal Imaging Probe (FLIP) as an Adjunctive Modality in Evaluation of Esophageal Dysmotility

2021 ◽  
Vol 1 (3) ◽  
pp. 286-295
Author(s):  
Domenico A. Farina ◽  
Dustin A. Carlson

The Functional Luminal Imaging Probe (FLIP) has emerged as a valuable adjunctive tool in the evaluation of esophageal diseases. Using volumetric distension, FLIP can assess secondary peristalsis and detect esophageal abnormalities that may not be evaluated by high-resolution manometry (HRM). In certain clinical settings, FLIP may allow for deferral of HRM. In therapy for esophageal diseases, FLIP has demonstrated value for its real-time interpretation, which can be used intra-procedurally to tailor therapy and to predict post-therapy outcomes. The future of FLIP looks promising as surgeons and gastroenterologists place increasing emphasis on non-manometric data to diagnose esophageal motility disorders.

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Dustin A. Carlson ◽  
Alexandra J. Baumann ◽  
Jacqueline E. Prescott ◽  
Jacob M. Schauer ◽  
Amanda Krause ◽  
...  

2011 ◽  
Vol 140 (5) ◽  
pp. S-229 ◽  
Author(s):  
Kee Wook Jung ◽  
Robert E. Kraichely ◽  
Amindra S. Arora ◽  
David A. Katzka ◽  
Yvonne Romero ◽  
...  

2018 ◽  
Vol 314 (3) ◽  
pp. G334-G340 ◽  
Author(s):  
Dustin A. Carlson ◽  
Peter J. Kahrilas ◽  
Katherine Ritter ◽  
Zhiyue Lin ◽  
John E. Pandolfino

Repetitive retrograde contractions (RRCs) in response to sustained esophageal distension are a distinct contractility pattern observed with functional luminal imaging probe (FLIP) panometry that are common in type III (spastic) achalasia. RRCs are hypothesized to be indicative of either impaired inhibitory innervation or esophageal outflow obstruction. We aimed to apply FLIP panometry to patients with postfundoplication dysphagia (a model of esophageal obstruction) to explore mechanisms behind RRCs. Adult patients with dysphagia after Nissen fundoplication ( n = 32) or type III achalasia ( n = 25) were evaluated with high-resolution manometry (HRM) and upper endoscopy with FLIP. HRM studies were assessed for outflow obstruction and spastic features: premature contractility, hypercontractility, and impaired deglutitive inhibition during multiple-rapid swallows. FLIP studies were analyzed to determine the esophagogastric junction (EGJ)-distensibility index and contractility pattern, including RRCs. Barium esophagram was evaluated when available. RRCs were present in 8/32 (25%) fundoplication and 19/25 (76%) achalasia patients ( P < 0.001). EGJ outflow obstruction was detected in 21 (67%) fundoplication patients by HRM, FLIP, or esophagram [6 (29%) had RRCs]. On HRM, none of the fundoplication patients had premature contractility, whereas 3/4 with defective inhibition on multiple-rapid swallows and 2/4 with hypercontractility had RRCs. Regression analysis demonstrated HRM with spastic features, but not esophageal outflow obstruction, as a predictor for RRCs. RRCs in response to sustained esophageal distension appear to be a manifestation of spastic esophageal motility. Although future study to further clarify the significance of RRCs is needed, RRCs on FLIP panometry should prompt evaluation for a major motor disorder. NEW & NOTEWORTHY Repetitive retrograde contractions (RRCs) are a common response to sustained esophageal distension among spastic achalasia patients when evaluated with the functional luminal imaging probe. We evaluated patients with postfundoplication dysphagia, i.e., patients with suspected mechanical obstruction, and found that RRCs occasionally occurred among postfundoplication patients, but often in association with manometric features of esophageal neuromuscular imbalance. Thus, RRCs appear to be a manifestation of spastic esophageal dysmotility, likely from neural imbalance resulting in excess excitation.


2020 ◽  
Vol 158 (6) ◽  
pp. S-1095-S-1096
Author(s):  
Wei-Yi Lei ◽  
Jen-Hung Wang ◽  
Ming-Wun Wong ◽  
Chih-Hsun Yi ◽  
Tso-Tsai Liu ◽  
...  

2010 ◽  
Vol 24 (5) ◽  
pp. 299-304 ◽  
Author(s):  
S. Roman ◽  
A. Hot ◽  
N. Fabien ◽  
J.-F. Cordier ◽  
P. Miossec ◽  
...  

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