New paper presents characteristic data of the pylorus using EndoFLIP
3rd March 2015
A new paper has been published in Neurogastroenterology and Motility. This 54 patient study from Malik et al from Temple University discusses practical aspects of making measurements of the pylorus using EndoFLIP, and provides early normative data of pylorus physiology in patients with Gastroparesis.
The study demonstrates that early satiety and postprandial fullness are inversely correlated with the diameter of the pyloric sphincter.
Assessing pyloric sphincter pathophysiology using EndoFLIP in patients with gastroparesis.
Malik Z, Sankineni A, Parkman HP.
Neurogastroenterol Motil. 2015 Feb 24. doi: 10.1111/nmo.12522. [Epub ahead of print]
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.
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.
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.