Esophagogastric junction distensibility assessed using the functional lumen imaging probe

Area of Science:

• Gastroenterology
• Esophageal Physiology
• Medical Device Technology

Background:

• Functional Lumen Imaging Probe (FLIP) is increasingly used to assess esophageal function.
• Standardized reference values for esophageal distensibility and cross-sectional area are needed for accurate interpretation of FLIP data.

Purpose of the Study:

• To systematically review and synthesize existing literature on esophageal distensibility and cross-sectional area reference values obtained via FLIP.
• To compare these values in healthy individuals, achalasia patients, and gastroesophageal reflux disease (GERD) patients.

Main Methods:

• A systematic literature search was conducted in Medline and Embase following PRISMA guidelines.
• Data on cross-sectional area and distensibility at the esophagogastric junction (EGJ) were extracted from included studies.
• Analysis was stratified by patient group (healthy, achalasia, GERD) and FLIP parameters (balloon length, inflation volume).

Main Results:

• Included studies comprised 6 achalasia (n=154), 3 GERD (n=52), and 5 healthy control (n=98) cohorts.
• Healthy volunteer data showed wide variability; achalasia patients exhibited significantly low pre-treatment distensibility (≤ 1.6 mm²/mmHg) that improved post-treatment (≥ 3.4 mm²/mmHg).
• GERD patients undergoing fundoplication demonstrated a marked decrease in EGJ distensibility, falling within the range of untreated achalasia.

Conclusions:

• FLIP is a valuable tool for evaluating treatment effectiveness in achalasia.
• Post-fundoplication EGJ distensibility changes highlight the importance of considering esophageal body motility and pre-operative dysmotility screening.
• Standardized FLIP protocols and consistent balloon sizing are crucial for future research and clinical application.