Use of Impedance Planimetry (Endoflip) in Foregut Surgery Practice: Experience of More than 400 Cases

The use of impedance planimetry (Endoscopic Functional Lumen Imaging Probe, EndoFLIP®) in the gastrointestinal tract: A systematic review

“…A significant decrease of the EGJ DI was found for Heller myotomy 7,14,17‐22 and pneumatic dilation 7,8,14,23,24 (LE 3). Similar results were found regarding POEM (Per Oral Esophageal Myotomy), with a significant increase of the EGJ DI found in most studies immediately after POEM 16‐20,25‐28 or at 3 months 29 (LE 3). Intraoperative evaluation of EGJ during POEM showed that both submucosal tunnel creation and myotomy (6 cm proximal to the EGJ to 2‐3 cm distal) caused an increase in EGJ DI 19,20,26 (LE 3).…”

“…The EGJ changes following fundoplication (FP) were also evaluated in nine studies, but EndoFLIP ® protocol varied among studies (Table 5), in particular regarding the timing of EGJ evaluation during FP: before, after pneumoperitoneum or after completion of the FP. Most studies showed a significant decrease of EGJ DI immediately after completion of FP 17,40,43‐45 (LE 3) and this despite the type of FP (ie, Nissen or Toupet FP) in one study 43 (LE 3) but not in another study 44 (LE 4). Moreover, the importance of the timing of EGJ evaluation during FP was also demonstrated.…”

“…This contrasts with gastric emptying measurement which is poorly correlated with symptoms or quality of life 71‐73 (LE 3). This suggests therefore that pyloric distensibility may be a clinically relevant tool in a subset of gastroparetic patients to better identify precisely one of the underlying mechanisms involved in gastric retention 17,80 …”

“…If the use of EndoFLIP ® eliminated the need for a bougie in this study without dysphagia or GERD symptoms at 1 month, there is a need to confirm these findings in further large prospective studies with a longer time of follow‐up. Lastly, some studies on fundoplication in GERD patients included a low number of patients with HH, but without particular analysis of this subgroup of patients 17,42,45,47,48 …”

Intraoperative Impedance Planimetry (ENDOFLIP)

“…14 EndoFLIP measurements can guide intraoperative decision making, Su et al shared cases that if the DI after crural closure was overly high or low, then a crural stitch was removed or additional stich was placed, respectively. 18 These studies show that the EndoFLIP can impact outcomes by allowing the surgeon to tailor surgical management of GERD. This can lead to an ideal fundoplication where GERD symptoms are relieved in addition to ease in esophageal emptying and the ability to vent swallowed air.…”