Functional Lumen Imaging Probe Is Useful for the Quantification of Gastric Sleeve Stenosis and Prediction of Response to Endoscopic Dilation: a Pilot Study

Intestinal strictures affect one-third of patients with Crohn's disease (CD) within 10 years of disease onset. Quantification of fibrosis and/or inflammation within the stricture may help in choosing the appropriate treatment. Current endoscopic imaging modalities could benefit from the transmural characterization of tissue modeling from fibrosis. We report the application of EndoFLIP during balloon dilation and stricturotomy of CD-related ileocolonic anastomotic stricture. A low EndoFLIP distensibility was noted which improved after endotherapy. This proof-of-concept application supports the use of EndoFLIP to characterize CD anastomotic stricture and real-time assessment of response to endotherapy.

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“…For gastric sleeve stenosis, a large postdilation diameter and distensibility are predictors of adequate treatment response. 6…”

Section: Discussionmentioning

confidence: 99%

Impedance Planimetry for Crohn's Disease Anastomotic Stricture Characterization: A Predictor of Treatment Response?

et al. 2022

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“…Accurate identification of the clinically significant stenotic segment is key, particularly in the setting of helical stenoses. We used a combination of endoscopic and radiologic findings; however, impedance planimetry has also been reported [11]. Once the stenotic segment had been identified, the mucosotomy site was determined and submucosal tunneling was performed to achieve an efficient tunnel that avoided myotomy of the LES and pylorus.…”

Section: Discussionmentioning

confidence: 99%

Gastric per-oral endoscopic myotomy (G-POEM) for the treatment of gastric sleeve stenosis: a feasibility and safety study

et al. 2021

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Background/aims: Traditional endoscopic treatments have limited success for treatment of gastric sleeve stenosis (GSS). Gastric peroral endoscopic myotomy (G-POEM) could conceivably obliterate the twist/angulation that causes GSS through a tunneled stricturotomy (instead of pyloromyotomy). We report early outcomes of G-POEM for GSS treatment. Methods: We retrospectively reviewed all patients with GSS treated with G-POEM at a single center. The primary endpoint was clinical success, defined as symptom improvement with resumption of adequate oral intake, without requiring further intervention. Results: 13 patients (12 female, mean age 43±10.9 years) underwent G-POEM for predominantly helical (n=11, 85%) GSS. Three (23%) had concurrent sleeve leak and ten (77%) had prior GSS treatment. There were two intraoperative AEs resulting in no deviation to the procedure. No major AEs occurred. At a median 175 (IQR119-260) days follow up, clinical success was achieved in 10 patients (77%). Median GCSI score in responders decreased post-G-POEM from 2.06 (IQR1.5-2.8) to 0.39 (IQR0.2-0.5). Three patients (23%) required surgical revision. Conclusions: G-POEM is a feasible and safe technique which may provide an alternative option for those averse to undergoing surgical revision for treatment of GSS.

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“…Several series have explored the role of FLIP in the evaluation of upper esophageal sphincter (UES) function in healthy controls, in patients with upper esophageal strictures, and sleeve gastrectomy stenoses before and after treatment. 61 The role of FLIP has also been explored in patients undergoing gastric POEM. 8,62 In a multicenter study of 37 patients, intraoperative postmyotomy CSA using 40-mL distention was shown to correlate with improvement in gastric emptying and clinical success.…”

Section: Technology Under Review Functional Luminal Imaging Probementioning

confidence: 99%

Section: Technology Under Reviewmentioning

confidence: 99%

Devices for esophageal function testing

et al. 2022

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Background and Aims Esophageal function testing is an integral component of the evaluation of refractory GERD and esophageal motility disorders. This review summarizes the current technologies available for esophageal function testing, including the functional luminal imaging probe (FLIP), high-resolution esophageal manometry (HRM), and multichannel intraluminal impedance (MII) and pH monitoring. Methods We performed a MEDLINE, PubMed, and MAUDE database literature search to identify pertinent clinical studies through March 2021 using the following key words: esophageal manometry, HRM, esophageal impedance, FLIP, MII, and esophageal pH testing. Technical data were gathered from traditional and web-based publications, proprietary publications, and informal communications with pertinent vendors. The report was drafted, reviewed, and edited by the American Society for Gastrointestinal Endoscopy Technology Committee and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy. Results FLIP is a high-resolution impedance planimetry system used for pressure and dimension measurement in the esophagus, pylorus, and anal sphincter. FLIP provides complementary information to HRM for esophageal motility disorders, especially achalasia. The Chicago classification, based on HRM data, is a widely adopted algorithmic scheme used to diagnose esophageal motility disorders. MII detects intraluminal bolus movement and, combined with pH measurement or manometry, provides information on acid and non-acid gastroesophageal reflux and bolus transit in patients with refractory GERD and for preoperative evaluation for anti-reflux procedures. Conclusions Esophageal function testing techniques (FLIP, HRM, and MII-pH) have diagnostic and prognostic value in the evaluation of esophageal motility disorders and refractory GERD. Newer technologies and classification systems have enabled an increased understanding of these diseases.

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Functional Lumen Imaging Probe Is Useful for the Quantification of Gastric Sleeve Stenosis and Prediction of Response to Endoscopic Dilation: a Pilot Study

Cited by 22 publications

References 8 publications

Impedance Planimetry for Crohn's Disease Anastomotic Stricture Characterization: A Predictor of Treatment Response?

Impedance Planimetry for Crohn's Disease Anastomotic Stricture Characterization: A Predictor of Treatment Response?

Gastric per-oral endoscopic myotomy (G-POEM) for the treatment of gastric sleeve stenosis: a feasibility and safety study

Devices for esophageal function testing

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