Original articleClinical endoscopyEsophagogastric junction distensibility assessed with an endoscopic functional luminal imaging probe (EndoFLIP)

BackgroundIncreased 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.ObjectivesThe 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.DesignProspective case-control series.SettingTertiary referral center.SubjectsTwenty GERD patients and 20 controls studied during a routine esophagogastroduodenoscopy.MethodsThe 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 MeasurementEGJ distensibility was assessed with 10- to 40-mL volume-controlled distentions.ResultsIn 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.LimitationsHeterogeneity of GERD patients.ConclusionsMeasurement 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.