Functional Lumen Imaging Probe: Difference between revisions

Revision as of 20:45, 29 June 2021

Revision as of 15:36, 8 January 2022

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| Name = Functional Lumen Imaging Probe

| Synonym = FLIP, EndoFlip

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| Caption =

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'''Functional Lumen Imaging Probe''' ('''FLIP''') is a test used to evaluate the function of the [[esophagus]], by measuring the dimensions of the esophageal lumen using [[electrical impedance|impedance]] [[planimetry]]. Typically performed with sedation during [[upper endoscopy]], FLIP is used to evaluate for [[esophageal motility disorders]], such as [[achalasia]], [[diffuse esophageal spasm]], etc.<ref name=Savarino />

==Procedure==

FLIP is most often performed immediately following upper endoscopy (EGD).<ref name=Savarino /> EGD helps to rule out a mechanical obstruction as a cause for symptoms, and also provides an estimation on the distance from the incisors to the EGJ.<ref name=Savarino />

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Following upper endoscopy, the balloon is inserted into the esophagus and the balloon is distended with a fluid with known properties (e.g. conductivity and volume).<ref name=Savarino /> Each electrode then measures impedance, and a single pressure sensor at the end of the device measures pressure within the balloon.<ref name=Savarino />

==Results==

The distensibility index (DI) is the most studied and most helpful result obtained with FLIP testing.<ref name=Savarino /> The normal DI ranges from 3.1 to 9.0 mm2 per mmHg.<ref name=Savarino /> As the balloon is distended, the results of secondary esophageal secondary contractions may be seen via FLIP panometry.<ref name=Savarino /> Possible results may include: repetitive anterograde contractions (a normal finding), repetitive retrograde contractions (abnormal), absent contractility, and other abnormalities.<ref name=Savarino />

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While recommendations exist for its use, the evidence supporting the use of FLIP is of very low quality and further research would be useful in more clearly defining its role.<ref>{{cite journal |last1=Massey |first1=BT |title=Clinical Functional Lumen Imaging Probe Testing in Esophageal Disorders: A Need for Better Quality Evidence. |journal=The American Journal of Gastroenterology |date=November 2020 |volume=115 |issue=11 |pages=1799–1801 |doi=10.14309/ajg.0000000000000974 |pmid=33156098}}</ref><ref>{{cite journal |last1=Massey |first1=BT |title=Flip Technology for Assessing Esophageal Structural and Motor Disorders: a Skeptic's View. |journal=Current Gastroenterology Reports |date=10 July 2020 |volume=22 |issue=9 |pages=44 |doi=10.1007/s11894-020-00782-2 |pmid=32651682|s2cid=220462184 }}</ref>

==History==

Early development of impedance planimetry for evaluating the gastrointestinal tract began in the 1980s.<ref name=Gregersen>{{cite journal |last1=Gregersen |first1=H |last2=Lo |first2=KM |title=What Is the Future of Impedance Planimetry in Gastroenterology? |journal=Journal of Neurogastroenterology and Motility |date=30 April 2018 |volume=24 |issue=2 |pages=166–181 |doi=10.5056/jnm18013 |pmid=29605974|pmc=5885717 |doi-access=free }}</ref> FLIP was first developed with a short balloon catheter, which measures distension across the esophagogastric junction.<ref name=DeVault /> A second generation device was later released, which measures secondary peristalsis proximal to the EGJ.<ref name=DeVault>{{cite journal |last1=DeVault |first1=KR |title=Functional luminal imaging probe: an evolving technology for the diagnosis of esophageal motility disorders. |journal=Gastrointestinal Endoscopy |date=December 2019 |volume=90 |issue=6 |pages=924–925 |doi=10.1016/j.gie.2019.08.025 |pmid=31759418|doi-access=free }}</ref>