Gastrointestinal Endoscopy
Volume 72, Issue 2 , Pages 272-278, August 2010

Esophagogastric junction distensibility assessed with an endoscopic functional luminal imaging probe (EndoFLIP)

Current affiliations: Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA

Received 23 November 2009; accepted 26 November 2009. published online 14 June 2010.

Background

Increased esophagogastric junction (EGJ) compliance is a key abnormality in GERD leading to increased volumes of reflux. To date, EGJ distensibility has been measured only with investigational barostat-based prototype devices.

Objectives

The aim of the study was to test the endoscopic functional luminal imaging probe (EndoFLIP), a new commercially available technology designed to measure intraluminal distensibility, by assessing the EGJ of GERD patients and controls.

Design

Prospective case-control series.

Setting

Tertiary referral center.

Subjects

Twenty GERD patients and 20 controls studied during a routine esophagogastroduodenoscopy.

Methods

The EndoFLIP was passed through the endoscopic instrumentation channel and positioned across the EGJ. The EndoFLIP uses impedance planimetry to measure 16 cross-sectional areas (CSA) along with the corresponding intrabag pressure within a 4.6-cm cylindrical segment of a fluid-filled bag.

Main Outcome Measurement

EGJ distensibility was assessed with 10- to 40-mL volume-controlled distentions.

Results

In both groups, the least distensible locus at the EGJ was usually at the hiatus. As a group, GERD patients exhibited two- to threefold increased EGJ distensibility compared with controls, particularly at 20- to 30-mL distention volumes, values quantitatively similar to previous measurements with barostat-based devices. The endoscopic estimation of EGJ distensibility, the flap valve grade, correlated poorly with EndoFLIP measurements.

Limitations

Heterogeneity of GERD patients.

Conclusions

Measurement of EGJ distensibility with EndoFLIP is feasible during clinical endoscopy. Stratifying GERD patients according to this physiological parameter may facilitate the identification of patient subgroups responsive or unresponsive to medical or surgical treatments.

Abbreviations: CSA, cross-sectional area, EGJ, esophagogastric junction, FLIP, functional luminal imaging probe, LES, lower esophageal sphincter

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 DISCLOSURE: The following author disclosed a financial relationship relevant to this publication: J.E. Pandolfino Scientific Advisory Board member, Crospon Ltd. The other authors disclosed no financial relationships relevant to this publication. Supported and sponsored by Crospon Ltd, Galway, Ireland; grant R01 DC00646 (P.J. Kahrilas and J.E. Pandolfino) from the Public Health Service; and the 2008 AGA June and Donald O. Castell Esophageal Clinical Research Award (J.E. Pandolfino).

PII: S0016-5107(10)00142-2

doi:10.1016/j.gie.2010.01.069

Gastrointestinal Endoscopy
Volume 72, Issue 2 , Pages 272-278, August 2010

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