What is Endoluminal Functional Luminal-Imaging Probe or EndoFLIP®?

The EndoFLIP® is an innovative tool that provides real-time evaluation of the structural and functional properties of the digestive tract sphincters, such as the lower oesophageal sphincter, the pylorus and the anal sphincter.  

It is primarily used to study patients with swallowing difficulties, as well as to assess gastric emptying disorders, faecal incontinence and certain types of constipation. The technology is used in addition to other diagnostic studies after structural abnormalities, such as oesophageal strictures (narrowing of the oesophagus), and other obstructions have been ruled out through gastroscopy. 

The endoluminal functional lumen imaging probe (EndoFLIP®) is used alongside other tests to evaluate digestive tract motility disorders. Some of these tests are high-resolution oesophageal manometry, barium swallow and nuclear medicine studies. 

The test is used to: 

- Diagnose motility disorders in patients with swallowing problems and non-cardiac chest pain, when oesophageal manometry is inconclusive. 

- Evaluate the response to endoscopic treatment of motility disorders of the sphincter at the junction between the oesophagus and stomach, when the response to treatment is incomplete. 

- Study disorders related to swallowing difficulties after anti-reflux surgery. 

- Evaluate the oesophagus in systemic diseases that damage the digestive tract muscle. 

- Evaluate the elasticity of the pylorus (the sphincter between the stomach and the small intestine) in patients diagnosed with gastroparesis (which impairs stomach muscle movement), to determine if its contraction is increased and to offer the best treatment. 

- Study disorders at the end of the digestive tract, such as faecal incontinence and constipation. 

Because it requires a gastroscopy before being inserted, the test is contraindicated in patients with the following: 

- Oesophageal and pyloric strictures, which could prevent safe passage of the probe.  

- Upper gastrointestinal bleeding. 

Please keep in mind the following about the test:  

• A fasting period of at least 8 hours, covering solids and clear liquids, is required before the test. Some patients with suspected or previously diagnosed achalasia, who may have oesophageal food retention, are instructed to follow a liquid diet the day before the test and to fast for at least 12 hours.  

• Medications that affect oesophageal motility must be discontinued 48 hours before the test.  Such drugs include prokinetics, sedatives, calcium channel blockers, nitrates, anticholinergics (e.g. tricyclic antidepressants), β-adrenergic antagonists, loperamide, opiate antagonists and D2 agonists (e.g. levodopa and bromocriptine). If medical advice is not to discontinue these medications, the medical team must be informed of the medications involved. 

• You should bring all other recent diagnostic tests for the problem under study (X-rays, endoscopy, etc) on the day of the test. 

• At the end of the test, you must follow the standard post-care instructions for sedated gastroscopy, as indicated by the healthcare provider. No additional care is required due to the use of the EndoFLIP®.  

It is a diagnostic technique that assesses the resistance within the tube by measuring its diameter and ability to contract and relax.  Depending on these results, the most appropriate treatment is then planned. The main areas evaluated are the elasticity of the digestive tract itself, especially the upper part (oesophagus and stomach), and the sphincters.  

The endoluminal functional lumen imaging probe consists of a catheter with multiple sensors enclosed in a balloon filled with saline solution at carefully controlled predetermined pressures. As the balloon inflates, the catheter sensors record the pressure and cross-sectional area, so the elasticity of the oesophagus and sphincters can be calculated. 

The entire test usually lasts about 30 mins. 

Because this examination requires sedation and a gastroscopy, those complications inherent to sedation and gastroscopy apply. Oral catheter intubation can cause dental or oesophageal trauma with bleeding, pain, vasovagal reaction (decreased heart rate and blood pressure) or perforation. However, these events are rare.