Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Oct;70(10):3432-3442.
doi: 10.1007/s10620-025-09127-3. Epub 2025 Jun 27.

Subjective Assessment of the Pyloric Sphincter During Endoscopy and Its Correlation with FLIP Panometry

Ian Levenfus  1 , Amanda Bianca  1 , Juliane Hente  1 , Katja Petrowski  2 , Jochen Hardt  2 , Marian C Pott  1 , Daniel Pohl  3
Affiliations

Subjective Assessment of the Pyloric Sphincter During Endoscopy and Its Correlation with FLIP Panometry

Ian Levenfus et al. Dig Dis Sci. 2025 Oct.

Abstract

Background: Visual or haptic assessments of the pylorus during endoscopy may result in the diagnosis of a pylorospasm. However, subjective assessments may be affected by inter-rater variability, the antro-duodenal motility phase and the distance to scope. We evaluated to what extent the visual impression, the endoscopic resistance to pyloric intubation and gastric contents correlate with objectively determined values using EndoFLIP measurements.

Methods: Patients scheduled for FLIP panometry of the upper gastrointestinal tract due to esophageal or epigastric conditions from January 2021 until November 2022 were considered for the study. Inclusion criteria were an EndoFLIP measurement of the pylorus using a standardized protocol for distensibility assessment and documented subjective assessments during upper endoscopy. Statistical analyses including MANOVA and logistic regression were performed for group comparisons and to evaluate significance.

Results: A total of 184 patients (56% female; mean age 49 ± 17.6 years) were included. The subjective assessment modalities of gastric and pyloric dimensions during endoscopy demonstrated high specificity (> 80%) but low sensitivity (< 50%) in detecting pylorospasm. Group comparisons and post hoc tests revealed no consistent significance between different subjective ratings. Logistic regression analysis showed that objectively determined measurements of pyloric dimensions using FLIP panometry were superior to subjective assessments in identifying pyloric dysfunction.

Conclusion: Subjective assessments of the pylorus during endoscopy are not reliable for diagnosing pyloric dysfunction, such as pylorospasm. This highlights the importance of measurements, not estimates, in the evaluation of pyloric function.

Keywords: EndoFLIP; Gastroparesis; Gastroscopy; Motility; Pyloric dysfunction; Pylorospasm; Upper endoscopy.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interest: Daniel Pohl is a consultant for Medtronic. All other authors have no competing interest to disclose. The authors received no specific funding for this study. Ethical approval: The study was approved by the Cantonal Ethics Committee of Zurich (Institutional Review Board of the Canton of Zurich, BASEC-Nr. 2017-00930).

Figures

Fig. 1
Fig. 1
Assigned categories/ratings for different modalities of subjective assessment
Fig. 2
Fig. 2
Objective categories grouped based on distensibility measurements using a balloon volume (BV) of 65 ml
Fig. 3
Fig. 3
Mean distensibility and diameter values with standard deviation for different subjective assessment modalities and their distribution between different distensibility groups
See this image and copyright information in PMC

References

    1. Koch KL, Calles-Escandón J. Diabetic gastroparesis. Gastroenterol Clin North Am. 2015;44:39–57. 10.1016/j.gtc.2014.11.005. - PubMed
    1. Brzana RJ, Koch KL, Bingaman S. Gastric myoelectrical activity in patients with gastric outlet obstruction and idiopathic gastroparesis. Am J Gastroenterol. 1998;93:1803–1809. 10.1111/j.1572-0241.1998.00524.x. - PubMed
    1. Hassan SM, Mubarik A, Muddassir S, Haq F. Adult idiopathic hypertrophic pyloric stenosis—a common presentation with an uncommon diagnosis. J Community Hosp Intern Med Perspect. 2018;8:64–67. 10.1080/20009666.2018.1444905. - PMC - PubMed
    1. Mearin F, Camilleri M, Malagelada J-R. Pyloric dysfunction in diabetics with recurrent nausea and vomiting. Gastroenterology. 1986;90:1919–1925. 10.1016/0016-5085(86)90262-3. - PubMed
    1. Kwiatek MA, Pandolfino JE, Hirano I, Kahrilas PJ. Esophagogastric junction distensibility assessed with an endoscopic functional luminal imaging probe (EndoFLIP). Gastrointest Endosc. 2010;72:272–278. 10.1016/j.gie.2010.01.069. - PMC - PubMed

LinkOut - more resources