Improving functional esophageal surgery with a “smart” bougie: endoflip

Perretta, Silvana; Dallemagne, Bernard; McMahon, Barry P.; D’Agostino, Jacopo; Marescaux, Jacques

doi:10.1007/s00464-011-1611-7

Cited by 41 publications

(33 citation statements)

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“…As patients with fundoplication appear to have reduced EGJ distensibility compared with controls, 4 FLIP may be a useful tool to aid anti-reflux procedures (such as fundoplication) 24 . Several studies demonstrated the feasibility of intra-operative FLIP use during fundoplication and a consistent reduction in EGJ-distensibility immediately following fundoplication 24, 25 .…”

Section: Gastroesophageal Reflux Diseasementioning

confidence: 99%

Functional Lumen Imaging Probe for the Management of Esophageal Disorders: Expert Review From the Clinical Practice Updates Committee of the AGA Institute

Hirano

Pandolfino

Boeckxstaens

2017

Clinical Gastroenterology and Hepatology

188

133

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The functional luminal imaging probe (FLIP) is an FDA approved measurement tool utilized to measure simultaneous pressure and diameter to both diagnose and manage various upper gastrointestinal disorders. Additionally, this tool is also approved to guide therapy during bariatric procedures and specialized esophageal surgery. While it has been commercially available since 2009, as the endolumenal functional lumen imaging probe (EndoFLIP ®), the FLIP has had limited penetrance into clinical settings outside of specialized centers and this is primarily due to a paucity of data supporting its utility in general practice. However, data is accumulating that is providing guidance regarding emerging applications in the evaluation and management of foregut disorders. Thus, the aim of this Clinical Practice Update is to describe the technique and review potential indications in achalasia, eosinophilic esophagitis and GERD.

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Section: Gastroesophageal Reflux Diseasementioning

confidence: 99%

Functional Lumen Imaging Probe for the Management of Esophageal Disorders: Expert Review From the Clinical Practice Updates Committee of the AGA Institute

Hirano

Pandolfino

Boeckxstaens

2017

Clinical Gastroenterology and Hepatology

188

133

View full text Add to dashboard Cite

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“…Median Eckardt score before POEM was 8 (range [5][6][7][8][9][10][11][12]. Thirteen patients had a type I achalasia at high-resolution manometry; 10 a type-II.…”

Section: Resultsmentioning

confidence: 99%

EndoFLIP system for the intraoperative evaluation of peroral endoscopic myotomy

et al. 2014

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Background: Peroral endoscopic myotomy (POEM) has been recently introduced in clinical practice for the treatment of achalasia. The endoluminal functional lumen imaging probe (EndoFLIP) system) uses impedance planimetry for the realtime measurement of the diameter of the oesophago-gastric junction. Objective: The aim of this study is to prospectively evaluate the effect of POEM on the oesophago-gastric junction using EndoFLIP. Methods: All the patients who underwent POEM in a single centre between April and July 2013 were enrolled in the study. EndoFLIP was used intraoperatively, immediately before and after POEM. During follow-up patients underwent oesophagogastroduodenoscopy, oesophageal pH monitoring and manometry. Clinical outcomes were compared with the diameter of the oesophago-gastric junction after POEM. Results: In total, 23 patients (12 males, mean age 51.7 years) were enrolled, and 21 underwent POEM successfully. Preoperative mean basal lower oesophageal sphincter pressure was 42.1 mmHg (AE17.6). Before POEM, the mean oesophago-gastric junction diameter and cross-sectional area were 6.3 mm (AE1.8) and 32.9 mm 2 (AE23.1), respectively. After treatment, the mean diameter and cross-sectional area of the oesophago-gastric junction were 11.3 mm (AE1.7 SD) and 102.38 mm 2 (AE28.2 SD), respectively. No complications occurred during a mean follow-up of 5 months. Median postoperative Eckardt score was 1. Three patients (14.3%) referred heartburn. Follow-up studies revealed gastro-oesophageal reflux disease (GORD) in 57.1% of patients and oesophagitis in 33.3%. No correlations were observed between the diameter of oesophago-gastric junction after POEM and symptoms relief, GORD incidence and lower oesophageal sphincter pressure. Conclusions: The diameter of oesophago-gastric junction substantially increases after POEM. EndoFLIP is a reliable method for the intraoperative evaluation of oesophago-gastric junction diameter. However, the real usefulness of this technology after POEM remains controversial.

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“…The first suggested intraoperative use of the FLIP for surgery was by Perretta et al [52]. A more recent study has indicated that intraoperative measurement of the distensibility of the EGJ using the FLIP can predict the clinical outcome of Heller myotomy and POEM [51].…”

Section: Achalasiamentioning

confidence: 99%

Functional lumen imaging of the gastrointestinal tract

et al. 2015

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This nonsystematic review aims to describe recent developments in the use of functional lumen imaging in the gastrointestinal tract stimulated by the introduction of the functional lumen imaging probe. When ingested food in liquid and solid form is transported along the gastrointestinal tract, sphincters provide an important role in the flow and control of these contents. Inadequate function of sphincters is the basis of many gastrointestinal diseases. Despite this, traditional methods of sphincter diagnosis and measurement such as fluoroscopy, manometry, and the barostat are limited in what they can tell us. It has long been thought that measurement of sphincter function through resistance to distension is a better approach, now more commonly known as distensibility testing. The functional lumen imaging probe is the first medical measurement device that purports in a practical way to provide geometric profiling and measurement of distensibility in sphincters. With use of impedance planimetry, an axial series of cross-sectional areas and pressure in a cathetermounted allantoid bag are used for the calculation of distensibility parameters. The technique has been trialed in many valvular areas of the gastrointestinal tract, including the upper esophageal sphincter, the esophagogastric junction, and the anorectal region. It has shown potential in the biomechanical assessment of sphincter function and characterization of swallowing disorders, gastroesophageal reflux disease, eosinophilic esophagitis, achalasia, and fecal incontinence. From this early work, the functional lumen imaging technique has the potential to contribute to a better and more physiological understanding of narrowing regions in the gastrointestinal tract in general and sphincters in particular.

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Improving functional esophageal surgery with a “smart” bougie: endoflip

Abstract: The endoflip provides a system in which physiology and anatomy are represented dynamically in the same image. This "smart bougie" could be integrated into the surgical routine to improve outcome and to facilitate surgical training and the learning curve in esophageal functional surgery.

Cited by 41 publications

References 0 publications

Functional Lumen Imaging Probe for the Management of Esophageal Disorders: Expert Review From the Clinical Practice Updates Committee of the AGA Institute

Functional Lumen Imaging Probe for the Management of Esophageal Disorders: Expert Review From the Clinical Practice Updates Committee of the AGA Institute

EndoFLIP system for the intraoperative evaluation of peroral endoscopic myotomy

Functional lumen imaging of the gastrointestinal tract

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