Assessment of Pyloric Sphincter Physiology Using Functional Luminal Imaging Probe in Healthy Volunteers

Abstract

Background/Aims The functional luminal imaging probe (FLIP) can measure tissue distensibility and geometric changes through volumetric distention. The esophagogastric junction has been well studied using EndoFLIP, studies on pylorus are lacking. We aim to study biomechanical properties of pylorus using EndoFLIP to create normative data. Methods We performed a prospective study of 20 healthy volunteers (ages, 18-54 years; 10 men) who underwent pylorus evaluation using 12cm FLIP placed across the pyloric sphincter. FLIP data were analyzed using FLIP planimetry plots at baseline and after administration of hyoscine butyl bromide injection. Results The median pylorus distensibility index (P-DI) was 8.37 mm 2 /mmHg (interquartile range, 4.22-13.04 mm 2 /mmHg) at 40 mL balloon volume. The 90th percentile at 40 mL balloon for P-DI was 14.89 mm 2 /mmHg, for cross-sectional area was 244.20 mm 2 /mmHg, and diameter and pressure were 17.58 mm and 48.84 mmHg, respectively. There was significant increase in P-DI after administration of hyoscine butyl bromide injection (P < 0.05). Conclusion The normative values can be used as reference values for pyloric distensibility. This reference can be used in studies of related to pyloric diseases such as gastroparesis.

Fasting pyloric diameter and distensibility by functional endoluminal imaging probe in unsedated healthy volunteers

“…For example, at 40 ml balloon distension, Jagtap et al reported similar values of pyloric DM, higher values of intraballoon pressure, and lower values of DI. 19 On the contrary, Gourcerol et al reported higher pyloric compliance (DI) and similar pyloric pressure. 20 These reported differences highlight the need for standardization in pyloric assessment with EndoFLIP ® and additional future studies.…”

“…This range of balloon distension volumes was the most widely used in prior studies. [6][7][8][9][10][11][12]19,20,23,24 Prior studies which used the EndoFLIP ® for the assessment of the esophagogastric junction (EGJ) showed increasing CSA with increasing volumes of balloon distention from 20-50 ml. 25 At the pylorus, there was less prominent increase in CSA with increasing balloon distention, compared with the EGJ.…”

“…[7][8][9][10][11][12] Opioids increase pyloric tone and cause antral hypomotility, 13,14 and propofol affects lower esophageal sphincter pressure, 15 duodenal contractility, 16 gastric emptying, 17 and colonic motility. 18 Only two prior studies have reported pyloric diameter and DI in healthy volunteers, one at 40 ml balloon distension under propofol, 19 and the other at 10, 20, 30, and 40 ml balloon distensions without sedation. 20 Our aim was to optimize measurement and establish normative diameter and DI data for the fasting pylorus in unsedated, healthy adults using the EndoFLIP ® .…”

Funktionsstörungen und Lebensqualität nach Ösophagusresektion

“…Der Nachweis erfolgt dann im Exhalat mithilfe eines Infrarotspektrometers und kann mit der Entleerungsgeschwindigkeit des Magens korreliert werden. Ein weiteres Verfahren zur planimetrischen Beurteilung der pylorischen Distensibilität steht seit Kurzem mit der Functional luminal Imaging Probe (FLIP) 53 , 54 zur Verfügung, wobei der klinische Stellenwert der Technik noch nicht abschließend evaluiert ist.…”

Functional syndromes and symptom-orientated aftercare after esophagectomy

“…Similarly, the 13 C-octanoate breath test monitors the transpyloric passage of a 13 C-isotope labeled meal. A new technique for planimetric assessment of pyloric distensibility has recently become available in the form of the Functional Luminal Imaging Probe (FLIP) [53,54], although the clinical value of the test has not yet been conclusively established.…”