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Review
. 2020 Jul;36(4):329-335.
doi: 10.1097/MOG.0000000000000639.

EsoFLIP for esophageal dilation: proposed advantages

Alexandra J Baumann  1 , Dustin A Carlson
Affiliations
Review

EsoFLIP for esophageal dilation: proposed advantages

Alexandra J Baumann et al. Curr Opin Gastroenterol. 2020 Jul.

Abstract

Purpose of review: The EsoFLIP integrates impedance planimetry technology into a dilator balloon capable of dilating from diameters between 10 and 30 mm via controlled volumetric distension while providing real-time visualization and objective measurement during the dilation procedure, potentially negating the need for fluoroscopy. This review aims to describe the use and application of EsoFLIP and the potential advantages this novel technology may afford.

Recent findings: Small pilot and retrospective studies demonstrate EsoFLIP feasibility and safety, but larger studies are needed to understand its impact on clinical outcomes.

Summary: EsoFLIP is an appealing new technology that offers advantages in therapeutic dilation of the lower esophageal sphincter in achalasia or of esophageal strictures because of previous surgery, gastroesophageal reflux disease, or radiation.

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Conflict of interest statement

Conflicts of interest:

Dustin A. Carlson: Medtronic (Speaking. Consulting. Shared intellectual property rights and ownership surrounding FLIP panometry systems, methods, and apparatus with Medtronic Inc.)

Alexandra J. Baumann: None

Figures

Figure 1.
Figure 1.. The EsoFLIP®.
A. The EsoFLIP® dilator. A wire can be threaded through a hole in the cap at the tip of the catheter (white arrow) to facilitate placement and positioning of the dilator; this wire runs externally to the balloon. B. Positioning of the balloon across and centered at the esophagogastric junction. (EGJ). C. Positioning can be visualized by the real-time display on the EndoFLIP® system via the hour-glass appearance with the waist representing the narrowing at the EGJ. The 14 serial diameter measures are also displayed with estimated diameter measures in mm at the right. The image here represents a 30-ml fill volume in the 30mm maximum diameter balloon (ES-330) in a patient with achalasia immediately prior to a therapeutic dilation – the diameter at the EGJ-waist measures 8.4mm. Original figure used with permission from the Esophageal Center at Northwestern.
Figure 2.
Figure 2.. EsoFLIP® dilation procedure.
The real-time FLIP images (top) with EsoFLIP® fill volume by time (middle) over the course of the EsoFLIP® dilation procedure during a 30mm dilation performed in a patient with achalasia are displayed. A) Initial positioning and esophagogastric junction (EGJ) waist measurement at the 30-ml fill volume; positioning supplemented here with the fluoroscopy (bottom); the EsoFLIP® balloon is outlined in white dashed line to aid visualization. The impedance planimetry electrodes within the balloon are radiopaque. B) After removal of the wire, the balloon is filled while the positioning is maintained with visualization of the waist. C) The 30mm diameter dilation target is achieved at the maximum fill volume; complete effacement of the balloon is achieved (and thus the waist is no longer visible). The corresponding fluoroscopy image (bottom) demonstrated that the positioning across the EGJ was maintained in this example. Direct visualization with the endoscope should be considered for dilation performed without fluoroscopy. D) The EGJ waist can be measured after dilation to gauge a response to the dilation. Original figure used with permission from the Esophageal Center at Northwestern.
See this image and copyright information in PMC

References

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      A pilot study investigating 30mm EsoFLIP® dilation of the LES in adults with achalasia. This article demonstrates therapeutic success without major complication.

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