title: Functional Lumen Imaging Probe for the Management of Esophageal Disorders: Expert Review From the Clinical Practice Updates Committee of the AGA Institute.
abstract: The functional luminal imaging probe is a Food and Drug Administration-approved measurement tool used to measure simultaneous pressure and diameter to guide management of various upper gastrointestinal disorders. Additionally, this tool is also approved to guide therapy during bariatric procedures and specialized esophageal surgery. Although it has been commercially available since 2009 as the endolumenal functional lumen imaging probe (EndoFLIP), the functional luminal imaging probe has had limited penetrance into clinical settings outside of specialized centers. This is primarily because of a paucity of data supporting its utility in general practice and a lack of standardized protocols and data analysis methodology. However, data are accumulating that are providing guidance regarding emerging applications in the evaluation and management of foregut disorders. This clinical practice update describes the technique and reviews potential indications in achalasia, eosinophilic esophagitis, and gastroesophgeal reflux disease. Best Practice Advice 1: Clinicians should not make a diagnosis or treatment decision based on functional lumen imaging probe (FLIP) assessment alone. Best Practice Advice 2: FLIP assessment is a complementary tool to assess esophagogastric junction opening dynamics and the stiffness of the esophageal wall. Best Practice Advice 3: Utilization should follow distinct protocols and analysis paradigms based on the disease state of interest. Best Practice Advice 4: Clinicians should not utilize FLIP in routine diagnostic assessments of gastroesophageal reflux disease. Best Practice Advice 5: FLIP should not be used to diagnose eosinophilic esophagitis but may have a role in severity assessment and therapeutic monitoring.
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Ikuo
authors.initials: I
authors.lastname: Hirano
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: John E
authors.initials: JE
authors.lastname: Pandolfino
authors.affiliation: Department of Gastroenterology, Translational Research Center for Gastrointestinal Disorders, University Hospital Leuven, Catholic University of Leuven, Leuven, Belgium.
authors.forename: Guy E
authors.initials: GE
authors.lastname: Boeckxstaens
mesh_terms: D004935:Esophageal Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D061848:Optical Imaging / Q000379:methods*; D017410:Practice Guidelines as Topic
keywords: Achalasia; Eosinophilic Esophagitis; Functional Lumen Imaging Probe; Gastroesophageal Reflux Disease; Impedance Planimetry