Assessing pyloric sphincter pathophysiology using Endo<scp>FLIP</scp> in patients with gastroparesis

Malik, Zubair; Sankineni, Abhinav; Parkman, Henry P.

doi:10.1111/nmo.12522

Cited by 130 publications

(110 citation statements)

References 20 publications

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“…At a 40 ml balloon volume, pyloric diameter did not differ between diabetic and idiopathic gastroparesis, and was not correlated to gastric emptying rate measured by scintigraphy. Symptom intensities of early satiety and postprandial fullness, measured with the Patient's Assessment of GastroIntestinal Symptoms (PAGI-SYM) questionnaire [12], were inversely correlated to pyloric diameter [11]. However, the lack of a control group is a limitation.…”

Section: Pyloric Resistancementioning

confidence: 99%

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Gastroparesis

Tack

Carbone

Rotondo

2015

Current Opinion in Gastroenterology

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The relationship between delay in gastric emptying, symptom pattern, and response to prokinetic therapy in gastroparesis is poor. In diabetes, gastroparesis is characterized by loss of ICCs, and this is inversely correlated to the number of CD206+ macrophages. Dietary interventions may help to alleviate symptoms. Tricyclic antidepressants do not provide symptomatic benefit to patients with idiopathic gastroparesis.

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Section: Pyloric Resistancementioning

confidence: 99%

“…Malik et al [11] used the EndoFLIP to measure pyloric resistance in 54 gastroparesis patients (39 idiopathic, 15 diabetic) during endoscopy. At a 40 ml balloon volume, pyloric diameter did not differ between diabetic and idiopathic gastroparesis, and was not correlated to gastric emptying rate measured by scintigraphy.…”

Section: Pyloric Resistancementioning

confidence: 99%

Gastroparesis

Tack

Carbone

Rotondo

2015

Current Opinion in Gastroenterology

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“…The volume of flow through a circular opening is proportional to the opening diameter of the lumen raised to the fourth power . Recent studies reported the use of an EndoFLIP on the pylorus in human subjects . Pyloric compliance inversely correlates with gastric emptying, but no correlation between pyloric pressure and gastric emptying was reported …”

Section: Introductionmentioning

confidence: 99%

“…Recent studies reported the use of an EndoFLIP on the pylorus in human subjects . Pyloric compliance inversely correlates with gastric emptying, but no correlation between pyloric pressure and gastric emptying was reported …”

Section: Introductionmentioning

confidence: 99%

Evaluation of the pylorus with concurrent intraluminal pressure and EndoFLIP in patients with nausea and vomiting

Snape

Lin

Agarwal

et al. 2016

Neurogastroenterology Motil

105

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Key Points• The aims of this study were to compare pyloric distensibility to pyloric pressure in patients with nausea and vomiting and to correlate pyloric distensibility to delays in gastric emptying. We found increased pyloric pressure in only 42% of patients with nausea, vomiting, and delayed gastric emptying. Decreased pyloric distensibility is significantly decreased with gastric retention >20%. There is no difference in manometric or EndoFLIP measurements in patients with diabetes mellitus, vagal damage, or idiopathic nausea and vomiting. AbstractBackground Nausea and vomiting occurs in gastroparesis due to diabetes mellitus or unknown causes. The aim of this study was to compare (i) pyloric distensibility to pyloric manometric pressure in patients with nausea and vomiting and (ii) to correlate distensibility with delays in gastric emptying. Methods Sleeve manometry and EndoFLIP were performed sequentially during the same endoscopy on 114 patients with nausea and vomiting (47 with diabetes mellitus and 67 with idiopathic cause) after a standardized gastric emptying study. The sleeve manometer was positioned fluoroscopically, and the EndoFLIP was placed endoscopically. Manometric pressure using a water-perfused catheter and distensibility using an EndoFLIP filled with 40 cc of saline were measured from the pylorus. Key Results The basal pyloric pressure was elevated (>10 mmHg) in 34 patients and was normal in 80 patients. The basal and peak pressures were similar in patient with normal and delayed gastric emptying (p > 0.05). There was a significant decrease in distensibility (8.0 AE 1.0 mm 2 /mmHg) in patients with gastric retention (>20% at 4 h) compared with patients (12.4 AE 1.4 mm 2 /mmHg) (p < 0.01) with normal gastric retention (<10%). Pressure measurements from the sleeve manometer and the EndoFLIP correlated (r = 0.29) (p < 0.002), and increased EndoFLIP balloon pressure (19.4 AE 1.4 mmHg) (p < 0.01) was associated with a severe delay in gastric emptying. Conclusions & Inferences Elevated basal pyloric pressure occurs in 42% of patients with nausea and vomiting and delayed emptying. Decreased pyloric distensibility occurs with nausea, vomiting, and delayed gastric emptying. The EndoFLIP is a useful tool in the evaluation of pyloric function in symptomatic patients.

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“…33 In addition, fasting pyloric compliance was found to decrease in a sub-group of gastroparetic patients, and dilation in these patients improved the quality of life scores. 34 The basal pyloric pressure was also found to be elevated in almost half of patients with nausea and vomiting and delayed gastric emptying.…”

Section: Gastroparesismentioning

confidence: 99%

Emerging Roles of the Endolumenal Functional Lumen Imaging Probe in Gastrointestinal Motility Disorders

Ata-Lawenko

Lee

2017

J Neurogastroenterol Motil

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Gastrointestinal sphincters play a vital role in gut function and motility by separating the gut into functional segments. Traditionally, function of sphincters including the esophagogastric junction is studied using endoscopy and manometry. However, due to its dynamic biomechanical properties, data on distensibility and compliance may provide a more accurate representation of the sphincter function. The endolumenal functional lumen imaging probe (EndoFLIP) system uses a multi-detector impedance planimetry system to provide data on tissue distensibility and geometric changes in the sphincter as measured through resistance to volumetric distention with real-time images. With the advent of EndoFLIP studies, esophagogastric junction dysfunction and other disorders of the stomach and bowels may be better evaluated. It may be utilized as a tool in predicting effectiveness of endoscopic and surgical treatments as well as patient outcomes.

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Assessing pyloric sphincter pathophysiology using EndoFLIP in patients with gastroparesis

Cited by 130 publications

References 20 publications

Gastroparesis

Gastroparesis

Evaluation of the pylorus with concurrent intraluminal pressure and EndoFLIP in patients with nausea and vomiting

Emerging Roles of the Endolumenal Functional Lumen Imaging Probe in Gastrointestinal Motility Disorders

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