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Henry P. Parkman - One of the best experts on this subject based on the ideXlab platform.
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endoflip and pyloric dilation for gastroparesis symptoms refractory to pyloromyotomy pyloroplasty
Digestive Diseases and Sciences, 2021Co-Authors: Asad Jehangir, Zubair Malik, Roman V. Petrov, Henry P. ParkmanAbstract:Gastroparesis patients may undergo pyloromyotomy/pyloroplasty for chronic refractory symptoms. However, some patients have persistent symptoms. It is unknown if balloon dilation may improve their symptoms. We aimed to (1) assess if pyloric through-the-scope (TTS) balloon dilation results in symptom improvement in gastroparesis patients with suboptimal response to pyloromyotomy/pyloroplasty and (2) determine endoscopic functional luminal imaging probe (EndoFLIP) characteristics of these patients before dilation. Patients with severe gastroparesis refractory to pyloromyotomy/pyloroplasty seen from 2/2019 to 3/2020 underwent pyloric TTS dilation after assessing the pyloric characteristics using EndoFLIP. Patients completed Gastroparesis Cardinal Symptom Index (GCSI) pre-procedurally, and GCSI and Clinical Patient Grading Assessment Scale (CPGAS) on follow-ups. Thirteen (ten females) patients (mean age 45.2 ± 5.1 years) with severe gastroparesis symptoms (mean GCSI total score 3.4 ± 0.3) after pyloromyotomy/pyloroplasty underwent pyloric TTS dilation. Overall, there was improvement in symptoms at 1-month follow-up (mean GCSI total score 3.0 ± 0.4, mean CPGAS score 1.6 ± 0.5, p < 0.05 for both), with five (38%) patients reporting symptoms somewhat/moderately better. The patients with symptom improvement had lower pre-dilation pyloric EndoFLIP distensibility at 30 ml, 40 ml, and 50 ml than patients with little/no improvement (all p < 0.05). In gastroparesis patients with refractory symptoms after pyloromyotomy/pyloroplasty, pyloric TTS dilation improved symptoms in about a third of the patients. Patients with symptom improvement had lower pre-dilation pyloric distensibility on EndoFLIP suggesting incomplete myotomy, pyloric muscle regeneration, or pyloric stricture. Pyloric EndoFLIP followed by TTS dilation seems to be a promising treatment for some patients with gastroparesis symptoms refractory to pyloromyotomy/pyloroplasty.
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endoflip and pyloric dilation for gastroparesis symptoms refractory to pyloromyotomy pyloroplasty
Digestive Diseases and Sciences, 2020Co-Authors: Asad Jehangir, Zubair Malik, Roman V. Petrov, Henry P. ParkmanAbstract:BACKGROUND Gastroparesis patients may undergo pyloromyotomy/pyloroplasty for chronic refractory symptoms. However, some patients have persistent symptoms. It is unknown if balloon dilation may improve their symptoms. AIMS We aimed to (1) assess if pyloric through-the-scope (TTS) balloon dilation results in symptom improvement in gastroparesis patients with suboptimal response to pyloromyotomy/pyloroplasty and (2) determine endoscopic functional luminal imaging probe (EndoFLIP) characteristics of these patients before dilation. METHODS Patients with severe gastroparesis refractory to pyloromyotomy/pyloroplasty seen from 2/2019 to 3/2020 underwent pyloric TTS dilation after assessing the pyloric characteristics using EndoFLIP. Patients completed Gastroparesis Cardinal Symptom Index (GCSI) pre-procedurally, and GCSI and Clinical Patient Grading Assessment Scale (CPGAS) on follow-ups. RESULTS Thirteen (ten females) patients (mean age 45.2 ± 5.1 years) with severe gastroparesis symptoms (mean GCSI total score 3.4 ± 0.3) after pyloromyotomy/pyloroplasty underwent pyloric TTS dilation. Overall, there was improvement in symptoms at 1-month follow-up (mean GCSI total score 3.0 ± 0.4, mean CPGAS score 1.6 ± 0.5, p < 0.05 for both), with five (38%) patients reporting symptoms somewhat/moderately better. The patients with symptom improvement had lower pre-dilation pyloric EndoFLIP distensibility at 30 ml, 40 ml, and 50 ml than patients with little/no improvement (all p < 0.05). CONCLUSIONS In gastroparesis patients with refractory symptoms after pyloromyotomy/pyloroplasty, pyloric TTS dilation improved symptoms in about a third of the patients. Patients with symptom improvement had lower pre-dilation pyloric distensibility on EndoFLIP suggesting incomplete myotomy, pyloric muscle regeneration, or pyloric stricture. Pyloric EndoFLIP followed by TTS dilation seems to be a promising treatment for some patients with gastroparesis symptoms refractory to pyloromyotomy/pyloroplasty.
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pyloric sphincter characteristics using endoflip in gastroparesis
Revista Portuguesa De Pneumologia, 2018Co-Authors: M. Saadi, Henry P. Parkman, Zubair Malik, Ron ScheyAbstract:Abstract Introduction and aims Pyloric sphincter abnormalities may be detected in gastroparesis. Botulinum toxin A (BoNT/A) injection into the pylorus has been used to treat gastroparesis with varying results. The aim of the present article was to assess whether pyloric sphincter characteristics using the endoscopic functional lumen imaging probe (EndoFLIP®) with impedance planimetry in patients with gastroparesis correlated with symptoms, gastric emptying, and therapeutic response to pyloric sphincter BoNT/A injection. Methods EndoFLIP® study was performed on patients undergoing gastroparesis treatment with BoNT/A. The gastroparesis cardinal symptom index (GCSI) was applied prior to treatment and at post-treatment weeks 2, 4, 8, and 12. Results Forty-four patients were enrolled (30 with idiopathic gastroparesis, 14 with diabetic gastroparesis). Smaller pyloric diameter, cross-sectional area (CSA), and distensibility correlated with worse vomiting and retching severity at baseline. Greater gastric retention tended to correlate with decreased CSA and pyloric distensibility. BoNT/A treatment resulted in a significant decrease in the GCSI score at 2 and 4 weeks after treatment, but not at post-treatment weeks 8 or 12. Nausea, early satiety, postprandial fullness, and upper abdominal pain improved up to 12 weeks, whereas loss of appetite, stomach fullness, and stomach visibly larger improved only up to 4 weeks. Retching and vomiting failed to improve. Greater pyloric compliance at baseline correlated with greater improvement in early satiety and nausea at 8 weeks and greater pyloric distensibility correlated with improvement in upper abdominal pain. Conclusions EndoFLIP® characteristics of the pylorus provided important pathophysiologic information in patients with gastroparesis, in relation to symptoms, gastric emptying, and predicting the response to treatment directed at the pylorus.
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Características del esfínter pilórico utilizando EndoFLIP® en gastroparesia
Elsevier, 2018Co-Authors: M. Saadi, Z. Malik, Henry P. Parkman, Ro ScheyAbstract:Resumen: Introducción y objetivos: Existen anormalidades en el esfínter pilórico que pueden ser detectadas en la gastroparesia. La inyección de toxina botulínica tipo A (BoNT/A) en el píloro ha sido utilizada en el tratamiento de gastroparesia con diversos resultados. El objetivo del presente artículo fue evaluar si existía correlación entre las características del esfínter pilórico observadas con el catéter luminal de imagen funcional (EndoFLIP®) con planimetría por impedancia en pacientes con gastroparesia, y síntomas, vaciamiento gástrico y respuesta terapéutica tras inyección de BoNT/A en esfínter pilórico. Métodos: El estudio con EndoFLIP® se llevó a cabo en pacientes en tratamiento para gastroparesia con BoNT/A. Se utilizó el índice de síntoma cardinal de gastroparesia (GSCI por sus siglas en inglés) antes del tratamiento y a las 2, 4, 8 y 12 semanas después del tratamiento. Resultados: Se reclutó a 44 pacientes (30 con gastroparesia idiopática, 14 con gastroparesia diabética). Se encontró correlación entre menor diámetro pilórico, área de sección transversal (AST) y distensibilidad, y vómito y arcadas más intensos en la evaluación basal. También se observó una tendencia a correlacionar de mayor retención gástrica con el AST y una distensibilidad pilórica disminuidas. El tratamiento con BoNT/A dio como resultado una disminución significativa en el GSCI a las 2 y 4 semanas después del tratamiento, pero no a las 8 o 12 semanas después. La náusea, la saciedad temprana, la plenitud posprandial y el dolor abdominal superior mejoraron hasta 12 semanas, mientras que la pérdida de apetito, la plenitud gástrica y el estómago visiblemente más grande mejoraron solo hasta 4 semanas. Las arcadas y el vómito no mejoraron. La elasticidad pilórica basal correlacionó con un mayor grado de mejora de saciedad temprana y náuseas a las 8 semanas, y la mayor distensibilidad pilórica correlacionó con una mejora en el dolor abdominal. Conclusiones: Las características del píloro observadas con EndoFLIP® proporcionaron información fisiopatológica importante relacionada a síntomas, vaciamiento gástrico y predicción de respuesta a tratamiento dirigido al píloro en pacientes con gastroparesia. Abstract: Introduction and aims: Pyloric sphincter abnormalities may be detected in gastroparesis. Botulinum toxin A (BoNT/A) injection into the pylorus has been used to treat gastroparesis with varying results. The aim of the present article was to assess whether pyloric sphincter characteristics using the endoscopic functional lumen imaging probe (EndoFLIP®) with impedance planimetry in patients with gastroparesis correlated with symptoms, gastric emptying, and therapeutic response to pyloric sphincter BoNT/A injection. Methods: EndoFLIP® study was performed on patients undergoing gastroparesis treatment with BoNT/A. The gastroparesis cardinal symptom index (GCSI) was applied prior to treatment and at post-treatment weeks 2, 4, 8, and 12. Results: Forty-four patients were enrolled (30 with idiopathic gastroparesis, 14 with diabetic gastroparesis). Smaller pyloric diameter, cross-sectional area (CSA), and distensibility correlated with worse vomiting and retching severity at baseline. Greater gastric retention tended to correlate with decreased CSA and pyloric distensibility. BoNT/A treatment resulted in a significant decrease in the GCSI score at 2 and 4 weeks after treatment, but not at post-treatment weeks 8 or 12. Nausea, early satiety, postprandial fullness, and upper abdominal pain improved up to 12 weeks, whereas loss of appetite, stomach fullness, and stomach visibly larger improved only up to 4 weeks. Retching and vomiting failed to improve. Greater pyloric compliance at baseline correlated with greater improvement in early satiety and náusea at 8 weeks and greater pyloric distensibility correlated with improvement in upper abdominal pain. Conclusions: EndoFLIP® characteristics of the pylorus provided important pathophysiologic information in patients with gastroparesis, in relation to symptoms, gastric emptying, and predicting the response to treatment directed at the pylorus. Palabras clave: Gastroparesia, EndoFLIP®, Toxina botulínica tipo A, Píloro, Diabetes, Keywords: Gastroparesis, EndoFLIP®, Botulinum toxin A, Pylorus, Diabete
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Pyloric sphincter characteristics using EndoFLIP® in gastroparesis
'Elsevier BV', 2018Co-Authors: M. Saadi, Henry P. Parkman, Zubair Malik, Ron ScheyAbstract:Introduction and aims: Pyloric sphincter abnormalities may be detected in gastroparesis. Botulinum toxin A (BoNT/A) injection into the pylorus has been used to treat gastroparesis with varying results. The aim of the present article was to assess whether pyloric sphincter characteristics using the endoscopic functional lumen imaging probe (EndoFLIP®) with impedance planimetry in patients with gastroparesis correlated with symptoms, gastric emptying, and therapeutic response to pyloric sphincter BoNT/A injection. Methods: EndoFLIP® study was performed on patients undergoing gastroparesis treatment with BoNT/A. The gastroparesis cardinal symptom index (GCSI) was applied prior to treatment and at post-treatment weeks 2, 4, 8, and 12. Results: Forty-four patients were enrolled (30 with idiopathic gastroparesis, 14 with diabetic gastroparesis). Smaller pyloric diameter, cross-sectional area (CSA), and distensibility correlated with worse vomiting and retching severity at baseline. Greater gastric retention tended to correlate with decreased CSA and pyloric distensibility. BoNT/A treatment resulted in a significant decrease in the GCSI score at 2 and 4 weeks after treatment, but not at post-treatment weeks 8 or 12. Nausea, early satiety, postprandial fullness, and upper abdominal pain improved up to 12 weeks, whereas loss of appetite, stomach fullness, and stomach visibly larger improved only up to 4 weeks. Retching and vomiting failed to improve. Greater pyloric compliance at baseline correlated with greater improvement in early satiety and náusea at 8 weeks and greater pyloric distensibility correlated with improvement in upper abdominal pain. Conclusions: EndoFLIP® characteristics of the pylorus provided important pathophysiologic information in patients with gastroparesis, in relation to symptoms, gastric emptying, and predicting the response to treatment directed at the pylorus. Resumen: Introducción y objetivos: Existen anormalidades en el esfínter pilórico que pueden ser detectadas en la gastroparesia. La inyección de toxina botulínica tipo A (BoNT/A) en el píloro ha sido utilizada en el tratamiento de gastroparesia con diversos resultados. El objetivo del presente artículo fue evaluar si existía correlación entre las características del esfínter pilórico observadas con el catéter luminal de imagen funcional (EndoFLIP®) con planimetría por impedancia en pacientes con gastroparesia, y síntomas, vaciamiento gástrico y respuesta terapéutica tras inyección de BoNT/A en esfínter pilórico. Métodos: El estudio con EndoFLIP® se llevó a cabo en pacientes en tratamiento para gastroparesia con BoNT/A. Se utilizó el índice de síntoma cardinal de gastroparesia (GSCI por sus siglas en inglés) antes del tratamiento y a las 2, 4, 8 y 12 semanas después del tratamiento. Resultados: Se reclutó a 44 pacientes (30 con gastroparesia idiopática, 14 con gastroparesia diabética). Se encontró correlación entre menor diámetro pilórico, área de sección transversal (AST) y distensibilidad, y vómito y arcadas más intensos en la evaluación basal. También se observó una tendencia a correlacionar de mayor retención gástrica con el AST y una distensibilidad pilórica disminuidas. El tratamiento con BoNT/A dio como resultado una disminución significativa en el GSCI a las 2 y 4 semanas después del tratamiento, pero no a las 8 o 12 semanas después. La náusea, la saciedad temprana, la plenitud posprandial y el dolor abdominal superior mejoraron hasta 12 semanas, mientras que la pérdida de apetito, la plenitud gástrica y el estómago visiblemente más grande mejoraron solo hasta 4 semanas. Las arcadas y el vómito no mejoraron. La elasticidad pilórica basal correlacionó con un mayor grado de mejora de saciedad temprana y náuseas a las 8 semanas, y la mayor distensibilidad pilórica correlacionó con una mejora en el dolor abdominal. Conclusiones: Las características del píloro observadas con EndoFLIP® proporcionaron información fisiopatológica importante relacionada a síntomas, vaciamiento gástrico y predicción de respuesta a tratamiento dirigido al píloro en pacientes con gastroparesia. Keywords: Gastroparesis, EndoFLIP®, Botulinum toxin A, Pylorus, Diabetes, Palabras clave: Gastroparesia, EndoFLIP®, Toxina botulínica tipo A, Píloro, Diabete
G. Gourcerol - One of the best experts on this subject based on the ideXlab platform.
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the use of impedance planimetry endoscopic functional lumen imaging probe endoflip in the gastrointestinal tract a systematic review
Neurogastroenterology and Motility, 2020Co-Authors: Charlotte Desprez, A. Leroi, Sabine Roman, G. GourcerolAbstract:BACKGROUND AND PURPOSE The EndoFLIP® system is a method of delineating impedance and was first designed to investigate the characteristics of the esophago-gastric junction. In the last decade, its use was widened to investigate other sphincteric and non-sphincteric systems of the gastrointestinal tract. The objective of the present systematic review was to summarize the available data in literature on the use of the EndoFLIP® system in the gastrointestinal tract, including sphincteric and non-sphincteric regions. We performed a systematic review in accordance with recommendations for systematic review using PRISMA guidelines without date restriction, until June 2020, using MEDLINE-PubMed, Cochrane Library, and Google Scholar databases. Only articles written in English were included in the present review. Five hundred and six unique citations were identified from all database combined. Of those, 95 met the inclusion criteria. There was a lack of standardization among studies in terms of anesthetic drugs use, probe placement, and inflation protocol. In most cases, only small cohorts of patients were included. Most studies investigated the EGJ, with a potential use of the EndoFLIP® to identify a subgroup of patients with achalasia and for intraoperative assessment of treatment efficacy in achalasia. However, the use of EndoFLIP® in the esophageal body (esophageal panometry), other esophageal diseases (gastro-esophageal reflux disease, eosinophilic esophagitis), and other sphincter regions (anal canal, pylorus) will need further confirmatory studies. The EndoFLIP® system provides detailed geometric data of the gastrointestinal lumen but further works are needed to determine its use in clinical practice.
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the diagnostic value of the functional lumen imaging probe versus high resolution anorectal manometry in patients with fecal incontinence
Neurogastroenterology and Motility, 2018Co-Authors: A. Leroi, V. Bridoux, P. Ducrotté, Chloe Melchior, C Charpentier, Celine Savoyecollet, Estelle Houivet, G. GourcerolAbstract:Background The functional lumen imaging probe (EndoFLIP® ) is a new technology that measures the distensibility of the anal canal represented by the anal distensibility index. The aims of this study were (i) to compare the anal distensibility index to anal pressure in a cohort of patients with fecal incontinence (FI) and (ii) to compare the diagnostic value of the EndoFLIP® to that of high-resolution anorectal manometry (HRAM) in the same cohort of patients. Methods Eighty-three consecutive patients with FI who underwent EndoFLIP® and HRAM assessments were enrolled. The diagnostic value of the EndoFLIP® was compared to that of HRAM and agreement between EndoFLIP® and HRAM data was assessed. Key results More than 70% of the patients diagnosed with anal deficiency at rest and/or during voluntary contractions by HRAM had the same diagnosis using the EndoFLIP® . Two patients with higher distensibility indexes at rest had normal anal resting pressures. Sixteen patients with a normal EndoFLIP® index (ie, normal distensibility index at rest and during voluntary contractions) had an abnormal HRAM result. Seven of these 16 patients (44%) had no sphincter lesion or neuropathic disorder that could explain an abnormal anal sphincter function. Conclusions & inferences We demonstrated that the anal distensibility index and HRAM results are largely in agreement. We did, however, identify several discrepancies between the two techniques, indicating that they may be complementary.
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Do endoflip assessments of anal sphincter distensibility provide more information on patients with fecal incontinence than high-resolution anal manometry?
Neurogastroenterology & Motility, 2016Co-Authors: G. Gourcerol, S. Granier, V. Bridoux, J. Menard, P. Ducrotté, A. LeroiAbstract:Background Anal manometry is the standard technique for evaluating anal sphincter function. However, the functional lumen imaging probe (EndoFLIP®) can be used to measure sphincter distensibility during volume‐controlled distensions. Our aims were (i) to assess anal distensibility in patients with fecal incontinence (FI) and in healthy subjects using the EndoFLIP® and (ii) to compare the results with anal pressures measured by 3D high‐resolution manometry (3D‐HRM) to determine whether the EndoFLIP® was more sensitive and specific for diagnosing FI than 3D‐HRM. Methods EndoFLIP® and 3D‐HRM assessments of 34 female FI patients and 40 healthy female subjects were performed. Anal distensibility was measured as the median cross‐sectional area at the narrowest point divided by the corresponding intra‐bag pressure at rest and during peak voluntary contraction and was expressed in mm2/mmHg. Key Results A 40‐mL anal distensibility index was selected for further comparisons as it provided the best discrimination between the FI patients and the healthy subjects. The index was significantly higher in the FI patients than in the healthy subjects at rest (p = 1.10−4) and during voluntary contraction (p = 1.10−4). The index at rest and during voluntary contraction appeared to be more appropriate than anal pressures for discriminating between FI patients and healthy subjects. Conclusions & Inferences The present study confirmed that FI is associated with an abnormally high distensibility index at rest and during voluntary contraction. The ability of the distensibility index to discriminate between FI patients and healthy subjects was significantly better than anal pressure.
Michael B Ujiki - One of the best experts on this subject based on the ideXlab platform.
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experience based expert consensus on the intra operative usage of the endoflip impedance planimetry system
Surgical Endoscopy and Other Interventional Techniques, 2021Co-Authors: Christy Dunst, Jon C. Gould, Paul Severson, Kirsten Newhams, Aaron Sachs, Blair A Jobe, Michael B UjikiAbstract:The Endoluminal Functional Lumen Imaging Probe (Endoflip™) is a balloon-based catheter that provides real-time, objective feedback regarding the distensibility of any sphincter in the gastrointestinal tract. Usage of the Functional Lumen Imaging Probe (FLIP) has not been standardized, which has limited the interpretation and generalizability of published data. The purpose of this consensus statement is to provide a standardized protocol for obtaining FLIP measurements in order to create a more uniform approach to data collection. Five expert foregut surgeons, all of whom utilize the FLIP system in their daily practice, convened on March 19, 2019, to create a standardized protocol for obtaining FLIP measurements during hiatal hernia repair and fundoplication, magnetic sphincter augmentation, laparoscopic Heller myotomy, and peroral endoscopic myotomy. Existing literature was presented and reviewed. Each step of the protocol was discussed in detail until a unanimous consensus was reached. A standardized protocol was developed for obtaining FLIP measurements during hiatal hernia repair and fundoplication, magnetic sphincter augmentation, laparoscopic Heller myotomy, and peroral endoscopic myotomy. The FLIP impedance planimetry system is the only technology available that provides surgeons an objective way to assess the tightness of a fundoplication or adequacy of a myotomy during an operation. While considerable research remains to correlate FLIP measurements to patient outcomes, this consensus statement will provide standardization of data collection among FLIP users that will enhance the understanding of future study results.
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significant changes in impedance planimetry endoflip measurements after peroral pyloromyotomy for delayed gastric emptying
Surgical Endoscopy and Other Interventional Techniques, 2021Co-Authors: Mikhail Attaar, Harry J Wong, Kristine Kuchta, Woody Denham, Stephen P Haggerty, John G Linn, Michael B UjikiAbstract:The endoluminal functional lumen imaging probe (FLIP) can be used to obtain real-time measurements of the diameter (Dmin), cross-sectional area (CSA), and distensibility of the pylorus before and after peroral pyloromyotomy (POP), an emerging endoscopic treatment for delayed gastric emptying. Our study aims to report our single-center experience in performing POP with FLIP measurements before and after pyloromyotomy. A retrospective review of a prospectively maintained gastroesophageal database was performed. Demographic and perioperative data, including intraoperative FLIP measurements of the pylorus before and after POP, were analyzed. Measurements were compared using paired t tests. Thirty-four patients underwent POP between February 2017 and July 2020. Twenty-three (67.7%) patients were male and the average age was 59 years. The etiology of delayed gastric emptying was post-vagotomy in 22 patients, idiopathic gastroparesis in 7 patients, and diabetic gastroparesis in 5 patients. There were no significant differences in pre-myotomy or post-myotomy FLIP measurements when comparing the post-vagotomy versus the gastroparesis groups. There were significant increases in Dmin, CSA, and distensibility index when comparing pre-myotomy and post-myotomy readings for all patients (all p < 0.001). At follow-up, 64.7% of patients reported resolution of all symptoms. POP is an effective intervention in patients with delayed gastric emptying. Significant changes in FLIP measurements before and after POP suggest that FLIP may be a useful adjunct in guiding the management of delayed gastric emptying.
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initial experience with endoscopic pyloromyotomy with description and video of technique
Journal of Gastrointestinal Surgery, 2019Co-Authors: Herbert M Hedberg, Joann Carbray, Michael B UjikiAbstract:Gastric per oral endoscopic myotomy (G-POEM) is a recently developed incisionless procedure to address gastroparesis. It has been previously described to treat medical and postsurgical gastroparesis. The present study is a case series of patients undergoing G-POEM for a variety of indications, both elective and urgent. IRB approval was obtained for retrospective review of a prospectively collected database including patients who underwent G-POEM during a 1.5-year period. Using an upper endoscope, a mucosotomy is made 2 cm proximal to the pylorus on the anterior surface of the stomach. A submucosal tunnel is made to the pylorus muscle, which is completed incised. When possible, Endoflip® was used to evaluate pyloric distensibility before and after the myotomy. Patient demographic factors, additional procedures, and other follow-up were collected by chart review. Elective cases were offered repeat gastric emptying study at 6 months. There were 17 patients available for review. The procedure was technically completed in all cases. There was one gastric perforation recognized on postoperative day two that was addressed with laparoscopy and omental patch. Median length of stay was zero days, and 13/17 (76%) of patients experienced symptomatic relief. Pyloric distensibility significantly decreased intraoperatively from 5.6 (± 1.7) to 10.8 (± 5.0) cm2/mmHg (p = 0.002). This limited case series demonstrates G-POEM to be a versatile procedure able to address gastroparesis in a variety of settings. Success rates are congruent with previously published reports, and one serious complication was able to be addressed laparoscopically. Endoflip® was able to verify a successful myotomy intraoperatively. This procedure is an attractive alternative to less effective non-invasive treatments and a more invasive laparoscopic pyloroplasty.
A. Leroi - One of the best experts on this subject based on the ideXlab platform.
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the use of impedance planimetry endoscopic functional lumen imaging probe endoflip in the gastrointestinal tract a systematic review
Neurogastroenterology and Motility, 2020Co-Authors: Charlotte Desprez, A. Leroi, Sabine Roman, G. GourcerolAbstract:BACKGROUND AND PURPOSE The EndoFLIP® system is a method of delineating impedance and was first designed to investigate the characteristics of the esophago-gastric junction. In the last decade, its use was widened to investigate other sphincteric and non-sphincteric systems of the gastrointestinal tract. The objective of the present systematic review was to summarize the available data in literature on the use of the EndoFLIP® system in the gastrointestinal tract, including sphincteric and non-sphincteric regions. We performed a systematic review in accordance with recommendations for systematic review using PRISMA guidelines without date restriction, until June 2020, using MEDLINE-PubMed, Cochrane Library, and Google Scholar databases. Only articles written in English were included in the present review. Five hundred and six unique citations were identified from all database combined. Of those, 95 met the inclusion criteria. There was a lack of standardization among studies in terms of anesthetic drugs use, probe placement, and inflation protocol. In most cases, only small cohorts of patients were included. Most studies investigated the EGJ, with a potential use of the EndoFLIP® to identify a subgroup of patients with achalasia and for intraoperative assessment of treatment efficacy in achalasia. However, the use of EndoFLIP® in the esophageal body (esophageal panometry), other esophageal diseases (gastro-esophageal reflux disease, eosinophilic esophagitis), and other sphincter regions (anal canal, pylorus) will need further confirmatory studies. The EndoFLIP® system provides detailed geometric data of the gastrointestinal lumen but further works are needed to determine its use in clinical practice.
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the diagnostic value of the functional lumen imaging probe versus high resolution anorectal manometry in patients with fecal incontinence
Neurogastroenterology and Motility, 2018Co-Authors: A. Leroi, V. Bridoux, P. Ducrotté, Chloe Melchior, C Charpentier, Celine Savoyecollet, Estelle Houivet, G. GourcerolAbstract:Background The functional lumen imaging probe (EndoFLIP® ) is a new technology that measures the distensibility of the anal canal represented by the anal distensibility index. The aims of this study were (i) to compare the anal distensibility index to anal pressure in a cohort of patients with fecal incontinence (FI) and (ii) to compare the diagnostic value of the EndoFLIP® to that of high-resolution anorectal manometry (HRAM) in the same cohort of patients. Methods Eighty-three consecutive patients with FI who underwent EndoFLIP® and HRAM assessments were enrolled. The diagnostic value of the EndoFLIP® was compared to that of HRAM and agreement between EndoFLIP® and HRAM data was assessed. Key results More than 70% of the patients diagnosed with anal deficiency at rest and/or during voluntary contractions by HRAM had the same diagnosis using the EndoFLIP® . Two patients with higher distensibility indexes at rest had normal anal resting pressures. Sixteen patients with a normal EndoFLIP® index (ie, normal distensibility index at rest and during voluntary contractions) had an abnormal HRAM result. Seven of these 16 patients (44%) had no sphincter lesion or neuropathic disorder that could explain an abnormal anal sphincter function. Conclusions & inferences We demonstrated that the anal distensibility index and HRAM results are largely in agreement. We did, however, identify several discrepancies between the two techniques, indicating that they may be complementary.
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Do endoflip assessments of anal sphincter distensibility provide more information on patients with fecal incontinence than high-resolution anal manometry?
Neurogastroenterology & Motility, 2016Co-Authors: G. Gourcerol, S. Granier, V. Bridoux, J. Menard, P. Ducrotté, A. LeroiAbstract:Background Anal manometry is the standard technique for evaluating anal sphincter function. However, the functional lumen imaging probe (EndoFLIP®) can be used to measure sphincter distensibility during volume‐controlled distensions. Our aims were (i) to assess anal distensibility in patients with fecal incontinence (FI) and in healthy subjects using the EndoFLIP® and (ii) to compare the results with anal pressures measured by 3D high‐resolution manometry (3D‐HRM) to determine whether the EndoFLIP® was more sensitive and specific for diagnosing FI than 3D‐HRM. Methods EndoFLIP® and 3D‐HRM assessments of 34 female FI patients and 40 healthy female subjects were performed. Anal distensibility was measured as the median cross‐sectional area at the narrowest point divided by the corresponding intra‐bag pressure at rest and during peak voluntary contraction and was expressed in mm2/mmHg. Key Results A 40‐mL anal distensibility index was selected for further comparisons as it provided the best discrimination between the FI patients and the healthy subjects. The index was significantly higher in the FI patients than in the healthy subjects at rest (p = 1.10−4) and during voluntary contraction (p = 1.10−4). The index at rest and during voluntary contraction appeared to be more appropriate than anal pressures for discriminating between FI patients and healthy subjects. Conclusions & Inferences The present study confirmed that FI is associated with an abnormally high distensibility index at rest and during voluntary contraction. The ability of the distensibility index to discriminate between FI patients and healthy subjects was significantly better than anal pressure.
Zubair Malik - One of the best experts on this subject based on the ideXlab platform.
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endoflip and pyloric dilation for gastroparesis symptoms refractory to pyloromyotomy pyloroplasty
Digestive Diseases and Sciences, 2021Co-Authors: Asad Jehangir, Zubair Malik, Roman V. Petrov, Henry P. ParkmanAbstract:Gastroparesis patients may undergo pyloromyotomy/pyloroplasty for chronic refractory symptoms. However, some patients have persistent symptoms. It is unknown if balloon dilation may improve their symptoms. We aimed to (1) assess if pyloric through-the-scope (TTS) balloon dilation results in symptom improvement in gastroparesis patients with suboptimal response to pyloromyotomy/pyloroplasty and (2) determine endoscopic functional luminal imaging probe (EndoFLIP) characteristics of these patients before dilation. Patients with severe gastroparesis refractory to pyloromyotomy/pyloroplasty seen from 2/2019 to 3/2020 underwent pyloric TTS dilation after assessing the pyloric characteristics using EndoFLIP. Patients completed Gastroparesis Cardinal Symptom Index (GCSI) pre-procedurally, and GCSI and Clinical Patient Grading Assessment Scale (CPGAS) on follow-ups. Thirteen (ten females) patients (mean age 45.2 ± 5.1 years) with severe gastroparesis symptoms (mean GCSI total score 3.4 ± 0.3) after pyloromyotomy/pyloroplasty underwent pyloric TTS dilation. Overall, there was improvement in symptoms at 1-month follow-up (mean GCSI total score 3.0 ± 0.4, mean CPGAS score 1.6 ± 0.5, p < 0.05 for both), with five (38%) patients reporting symptoms somewhat/moderately better. The patients with symptom improvement had lower pre-dilation pyloric EndoFLIP distensibility at 30 ml, 40 ml, and 50 ml than patients with little/no improvement (all p < 0.05). In gastroparesis patients with refractory symptoms after pyloromyotomy/pyloroplasty, pyloric TTS dilation improved symptoms in about a third of the patients. Patients with symptom improvement had lower pre-dilation pyloric distensibility on EndoFLIP suggesting incomplete myotomy, pyloric muscle regeneration, or pyloric stricture. Pyloric EndoFLIP followed by TTS dilation seems to be a promising treatment for some patients with gastroparesis symptoms refractory to pyloromyotomy/pyloroplasty.
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endoflip and pyloric dilation for gastroparesis symptoms refractory to pyloromyotomy pyloroplasty
Digestive Diseases and Sciences, 2020Co-Authors: Asad Jehangir, Zubair Malik, Roman V. Petrov, Henry P. ParkmanAbstract:BACKGROUND Gastroparesis patients may undergo pyloromyotomy/pyloroplasty for chronic refractory symptoms. However, some patients have persistent symptoms. It is unknown if balloon dilation may improve their symptoms. AIMS We aimed to (1) assess if pyloric through-the-scope (TTS) balloon dilation results in symptom improvement in gastroparesis patients with suboptimal response to pyloromyotomy/pyloroplasty and (2) determine endoscopic functional luminal imaging probe (EndoFLIP) characteristics of these patients before dilation. METHODS Patients with severe gastroparesis refractory to pyloromyotomy/pyloroplasty seen from 2/2019 to 3/2020 underwent pyloric TTS dilation after assessing the pyloric characteristics using EndoFLIP. Patients completed Gastroparesis Cardinal Symptom Index (GCSI) pre-procedurally, and GCSI and Clinical Patient Grading Assessment Scale (CPGAS) on follow-ups. RESULTS Thirteen (ten females) patients (mean age 45.2 ± 5.1 years) with severe gastroparesis symptoms (mean GCSI total score 3.4 ± 0.3) after pyloromyotomy/pyloroplasty underwent pyloric TTS dilation. Overall, there was improvement in symptoms at 1-month follow-up (mean GCSI total score 3.0 ± 0.4, mean CPGAS score 1.6 ± 0.5, p < 0.05 for both), with five (38%) patients reporting symptoms somewhat/moderately better. The patients with symptom improvement had lower pre-dilation pyloric EndoFLIP distensibility at 30 ml, 40 ml, and 50 ml than patients with little/no improvement (all p < 0.05). CONCLUSIONS In gastroparesis patients with refractory symptoms after pyloromyotomy/pyloroplasty, pyloric TTS dilation improved symptoms in about a third of the patients. Patients with symptom improvement had lower pre-dilation pyloric distensibility on EndoFLIP suggesting incomplete myotomy, pyloric muscle regeneration, or pyloric stricture. Pyloric EndoFLIP followed by TTS dilation seems to be a promising treatment for some patients with gastroparesis symptoms refractory to pyloromyotomy/pyloroplasty.
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pyloric sphincter characteristics using endoflip in gastroparesis
Revista Portuguesa De Pneumologia, 2018Co-Authors: M. Saadi, Henry P. Parkman, Zubair Malik, Ron ScheyAbstract:Abstract Introduction and aims Pyloric sphincter abnormalities may be detected in gastroparesis. Botulinum toxin A (BoNT/A) injection into the pylorus has been used to treat gastroparesis with varying results. The aim of the present article was to assess whether pyloric sphincter characteristics using the endoscopic functional lumen imaging probe (EndoFLIP®) with impedance planimetry in patients with gastroparesis correlated with symptoms, gastric emptying, and therapeutic response to pyloric sphincter BoNT/A injection. Methods EndoFLIP® study was performed on patients undergoing gastroparesis treatment with BoNT/A. The gastroparesis cardinal symptom index (GCSI) was applied prior to treatment and at post-treatment weeks 2, 4, 8, and 12. Results Forty-four patients were enrolled (30 with idiopathic gastroparesis, 14 with diabetic gastroparesis). Smaller pyloric diameter, cross-sectional area (CSA), and distensibility correlated with worse vomiting and retching severity at baseline. Greater gastric retention tended to correlate with decreased CSA and pyloric distensibility. BoNT/A treatment resulted in a significant decrease in the GCSI score at 2 and 4 weeks after treatment, but not at post-treatment weeks 8 or 12. Nausea, early satiety, postprandial fullness, and upper abdominal pain improved up to 12 weeks, whereas loss of appetite, stomach fullness, and stomach visibly larger improved only up to 4 weeks. Retching and vomiting failed to improve. Greater pyloric compliance at baseline correlated with greater improvement in early satiety and nausea at 8 weeks and greater pyloric distensibility correlated with improvement in upper abdominal pain. Conclusions EndoFLIP® characteristics of the pylorus provided important pathophysiologic information in patients with gastroparesis, in relation to symptoms, gastric emptying, and predicting the response to treatment directed at the pylorus.
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Pyloric sphincter characteristics using EndoFLIP® in gastroparesis
'Elsevier BV', 2018Co-Authors: M. Saadi, Henry P. Parkman, Zubair Malik, Ron ScheyAbstract:Introduction and aims: Pyloric sphincter abnormalities may be detected in gastroparesis. Botulinum toxin A (BoNT/A) injection into the pylorus has been used to treat gastroparesis with varying results. The aim of the present article was to assess whether pyloric sphincter characteristics using the endoscopic functional lumen imaging probe (EndoFLIP®) with impedance planimetry in patients with gastroparesis correlated with symptoms, gastric emptying, and therapeutic response to pyloric sphincter BoNT/A injection. Methods: EndoFLIP® study was performed on patients undergoing gastroparesis treatment with BoNT/A. The gastroparesis cardinal symptom index (GCSI) was applied prior to treatment and at post-treatment weeks 2, 4, 8, and 12. Results: Forty-four patients were enrolled (30 with idiopathic gastroparesis, 14 with diabetic gastroparesis). Smaller pyloric diameter, cross-sectional area (CSA), and distensibility correlated with worse vomiting and retching severity at baseline. Greater gastric retention tended to correlate with decreased CSA and pyloric distensibility. BoNT/A treatment resulted in a significant decrease in the GCSI score at 2 and 4 weeks after treatment, but not at post-treatment weeks 8 or 12. Nausea, early satiety, postprandial fullness, and upper abdominal pain improved up to 12 weeks, whereas loss of appetite, stomach fullness, and stomach visibly larger improved only up to 4 weeks. Retching and vomiting failed to improve. Greater pyloric compliance at baseline correlated with greater improvement in early satiety and náusea at 8 weeks and greater pyloric distensibility correlated with improvement in upper abdominal pain. Conclusions: EndoFLIP® characteristics of the pylorus provided important pathophysiologic information in patients with gastroparesis, in relation to symptoms, gastric emptying, and predicting the response to treatment directed at the pylorus. Resumen: Introducción y objetivos: Existen anormalidades en el esfínter pilórico que pueden ser detectadas en la gastroparesia. La inyección de toxina botulínica tipo A (BoNT/A) en el píloro ha sido utilizada en el tratamiento de gastroparesia con diversos resultados. El objetivo del presente artículo fue evaluar si existía correlación entre las características del esfínter pilórico observadas con el catéter luminal de imagen funcional (EndoFLIP®) con planimetría por impedancia en pacientes con gastroparesia, y síntomas, vaciamiento gástrico y respuesta terapéutica tras inyección de BoNT/A en esfínter pilórico. Métodos: El estudio con EndoFLIP® se llevó a cabo en pacientes en tratamiento para gastroparesia con BoNT/A. Se utilizó el índice de síntoma cardinal de gastroparesia (GSCI por sus siglas en inglés) antes del tratamiento y a las 2, 4, 8 y 12 semanas después del tratamiento. Resultados: Se reclutó a 44 pacientes (30 con gastroparesia idiopática, 14 con gastroparesia diabética). Se encontró correlación entre menor diámetro pilórico, área de sección transversal (AST) y distensibilidad, y vómito y arcadas más intensos en la evaluación basal. También se observó una tendencia a correlacionar de mayor retención gástrica con el AST y una distensibilidad pilórica disminuidas. El tratamiento con BoNT/A dio como resultado una disminución significativa en el GSCI a las 2 y 4 semanas después del tratamiento, pero no a las 8 o 12 semanas después. La náusea, la saciedad temprana, la plenitud posprandial y el dolor abdominal superior mejoraron hasta 12 semanas, mientras que la pérdida de apetito, la plenitud gástrica y el estómago visiblemente más grande mejoraron solo hasta 4 semanas. Las arcadas y el vómito no mejoraron. La elasticidad pilórica basal correlacionó con un mayor grado de mejora de saciedad temprana y náuseas a las 8 semanas, y la mayor distensibilidad pilórica correlacionó con una mejora en el dolor abdominal. Conclusiones: Las características del píloro observadas con EndoFLIP® proporcionaron información fisiopatológica importante relacionada a síntomas, vaciamiento gástrico y predicción de respuesta a tratamiento dirigido al píloro en pacientes con gastroparesia. Keywords: Gastroparesis, EndoFLIP®, Botulinum toxin A, Pylorus, Diabetes, Palabras clave: Gastroparesia, EndoFLIP®, Toxina botulínica tipo A, Píloro, Diabete
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assessing pyloric sphincter pathophysiology using endoflip in patients with gastroparesis
Neurogastroenterology and Motility, 2015Co-Authors: Zubair Malik, Abhinav Sankineni, Henry P. ParkmanAbstract:Background Pyloric dysfunction has been associated with gastroparesis, particularly diabetic gastroparesis. Endoscopic functional luminal imaging probe (EndoFLIP) uses 16 sensors inside a balloon that is inflated inside a sphincter to assess physiologic characteristics. The aim of this study was to measure the pressure, diameter, cross-sectional area (CSA), and distensibility of the pylorus using EndoFLIP in patients with gastroparesis. In addition, the relationship between pyloric pathophysiology with gastroparesis etiology, symptoms, and gastric emptying was assessed. Methods EndoFLIP was performed in 54 patients (39 idiopathic gastroparesis, 15 diabetic gastroparesis). The EndoFLIP catheter was passed endoscopically so that the balloon straddled the pylorus. Pressure, diameter, CSA, and distensibility of the pylorus were measured at 20, 30, 40, and 50 cc balloon volume. Key Results Pyloric sphincter contour was seen best at 40 cc balloon distension (diameter 12.2 ± 0.44 mm, CSA 125.2 ± 9.15 mm2, pressure 18.0 ± 1.23 mmHg, length 1.59 ± 0.34 cm, distensibility 10.7 ± 2.57 mm2/mmHg). There was a wide range seen in diameter (5.6–22.1 mm) and distensibility (1–55 mm2/mmHg) of the pylorus. Symptoms of early satiety and postprandial fullness were inversely correlated with pyloric sphincter diameter and CSA. No significant difference was seen between diabetic and idiopathic gastroparetics. Conclusions & Inferences EndoFLIP is a novel technique that can be used to assess pyloric physiologic characteristics. Early satiety and postprandial fullness were inversely correlated with diameter and CSA of the pyloric sphincter. No significant differences were seen comparing diabetic and idiopathic gastroparetics. This technology may be of benefit to help select patients with pyloric sphincter abnormalities.