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Esophageal Functional Lumen Imaging Probe (FLIP): How Can FLIP Enhance Your Clinical Practice?

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Abstract

Recent innovations in esophageal diagnostic testing have enhanced gastroenterology clinical practice by facilitating more nuanced and advanced evaluation of esophageal symptoms. Among these pivotal advances is the FDA-approved functional lumen imaging probe (FLIP), which utilizes impedance planimetry via volumetric distension of a catheter-mounted balloon at the time of sedated upper endoscopy, to acquire esophageal dimensions and pressures. In real time, FLIP can display cross-sectional areas (CSA) and distensibility indices (ratios of CSA to intra-balloon pressures) throughout the esophagus, most notably at the esophagogastric junction, as well as secondary peristaltic esophageal body contractile patterns. As the use of FLIP has progressively spread and permeated into the practice of clinical gastroenterology since its introduction, increasing data on and experiences with its applications have accumulated to guide its utility in clinical practice. In this current review developed for gastroenterologists and foregut surgeons across clinical practice, we provide an introduction to FLIP technology and metrics and discuss the clinical scenarios in which performance of or referral for FLIP may be helpful in the evaluation and management of patients with commonly encountered esophageal symptoms and disorders. Specifically, we discuss the potential applications and limitations of FLIP as a complementary diagnostic modality in patients with non-obstructive dysphagia, established or suspected achalasia spectrum disorders, eosinophilic esophagitis, gastroesophageal reflux disease and those undergoing esophageal surgery.

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Fig. 1
Fig. 2

The authors thank Dr. C. Prakash Gyawali from the Washington University School of Medicine for providing the image for c

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Abbreviations

CSA:

Cross-sectional area

DI:

Distensibility index

EGJ:

Esophagogastric junction

EGJOO:

Esophagogastric junction outflow obstruction

EOE:

Eosinophilic esophagitis

FLIP:

Functional lumen imaging probe

GERD:

Gastroesophageal reflux disease

HRM:

High-resolution manometry

IRP:

Integrated relaxation pressure

LES:

Lower esophageal sphincter

POEM:

Per-oral endoscopic myotomy

RAC:

Repetitive antegrade contractions

RRC:

Repetitive retrograde contractions

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Authors and Affiliations

  1. Division of Gastroenterology, Duke University School of Medicine, DUMC Box 3913, Durham, NC, 27710, USA

    Y. Claire Dorsey, Shai Posner & Amit Patel

  2. Division of Gastroenterology, Durham Veterans Affairs Medical Center, Durham, NC, USA

    Y. Claire Dorsey, Shai Posner & Amit Patel

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  1. Y. Claire Dorsey
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Dorsey, Y.C., Posner, S. & Patel, A. Esophageal Functional Lumen Imaging Probe (FLIP): How Can FLIP Enhance Your Clinical Practice?. Dig Dis Sci 65, 2473–2482 (2020). https://doi.org/10.1007/s10620-020-06443-8

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