From the Guidelines
EndoFLIP should be used as a useful adjunct test in the evaluation of patients with achalasia, particularly in cases when diagnosis is equivocal, as it provides real-time measurements of the esophageal diameter, pressure, and distensibility. This is based on the most recent evidence from the study published in Gastroenterology in 2024 1. The study highlights the importance of a comprehensive diagnostic workup, including clinical history, upper endoscopy, timed barium esophagram, and high-resolution manometry, with EndoFLIP being a valuable addition in certain cases.
The use of EndoFLIP is supported by other studies, including one published in Gastroenterology in 2024 1, which emphasizes the importance of a comprehensive evaluation in patients with achalasia, and another published in Gut in 2022 1, which discusses the role of oesophageal physiological testing, including EndoFLIP, in the diagnosis and management of eosinophilic oesophagitis. However, the most recent and highest quality study is the one published in 2024 1, which provides the strongest evidence for the use of EndoFLIP in the evaluation of achalasia.
Some key points to consider when using EndoFLIP include:
- It is a useful adjunct test in the evaluation of patients with achalasia, particularly in cases when diagnosis is equivocal
- It provides real-time measurements of the esophageal diameter, pressure, and distensibility
- It can help guide treatment decisions, such as the degree of dilation needed for achalasia or the effectiveness of anti-reflux procedures
- It works by using impedance planimetry technology, which measures electrical resistance across multiple sensors along the balloon to create a detailed functional map of the esophagus
Overall, the use of EndoFLIP is a valuable tool in the evaluation and management of achalasia, and its use should be considered in cases where diagnosis is uncertain or where treatment decisions need to be guided by more precise and personalized information.
From the Research
EndoFLIP Overview
- EndoFLIP is a diagnostic tool used to assess the mechanical properties of the esophagus, including pressure, diameter, distensibility, and topography 2.
- It can be used to evaluate esophageal motility disorders, such as achalasia, and to assess the contractility and distensibility of the esophagus 2.
- EndoFLIP has been shown to be useful in detecting achalasia patients with relatively low IRP, which can be difficult to diagnose using high-resolution manometry alone 2.
EndoFLIP in Achalasia Diagnosis
- Achalasia is a primary esophageal motor disorder characterized by absent peristalsis and failure of the lower esophageal sphincter (LES) to relax 3, 4.
- EndoFLIP can be used to assess the distensibility of the esophagogastric junction, which is decreased in achalasia 2.
- The use of EndoFLIP can provide additional information on the contractile activity and distensibility of the esophageal body in patients with achalasia 2.
Anesthesia Choice and EndoFLIP Measurements
- The choice of anesthesia can affect EndoFLIP measurements, with total intravenous anesthesia (TIVA) being preferred over general anesthesia with inhalational anesthetics (GAIA) 5.
- The use of sevoflurane-based GAIA may lead to misclassification of spastic disorders as type I achalasia, highlighting the importance of anesthesia choice in EndoFLIP measurements 5.
Treatment Options for Esophageal Motility Disorders
- Treatment options for esophageal motility disorders, including achalasia, vary depending on the diagnosis and severity of the condition 3, 4, 6.
- Potential treatment strategies for achalasia include medical therapy, endoscopic procedures, and surgery, while patients with esophageal hypermotility or hypomotility disorders may be candidates for medical therapy, endoscopic procedures, or lifestyle modifications 6.