Endoflip Test: Purpose, Test Details & Results

The Endoflip test is transforming how doctors understand and treat disorders of the gastrointestinal (GI) tract. Using advanced technology, Endoflip allows real-time, precise measurements of the function and flexibility of key GI sphincters and segments. Whether you’re a patient, caregiver, or medical professional, understanding the Endoflip test can empower informed decisions and better care. This article will walk you through the purpose of the Endoflip test, how it’s performed, and how the results inform diagnosis and treatment.

Purpose of Endoflip Test

Understanding the reason behind the Endoflip test is the first step in appreciating its value. Endoflip, short for Endoluminal Functional Lumen Imaging Probe, is designed to provide unique insights into the function and biomechanics of the GI tract, especially sphincters like the lower esophageal sphincter (LES) and the pylorus. These measurements help doctors diagnose and manage complex digestive conditions that were previously difficult to assess objectively.

Overview: Why Use the Endoflip Test?

The Endoflip test’s main purpose is to objectively measure how easily a GI sphincter or segment stretches and opens in response to pressure. This property, known as “distensibility,” is crucial for normal swallowing, food passage, and gastric emptying. Traditional tests, like manometry and imaging studies, often can’t provide this detailed physiological information.

Diagnosing and Understanding GI Disorders

• Gastroparesis: In patients with delayed stomach emptying, Endoflip helps determine if the pylorus (the stomach’s exit valve) is too stiff or doesn’t open properly, which can lead to symptoms like nausea and vomiting. This can guide decisions on interventions such as botulinum toxin injections or surgical procedures like G-POEM (gastric peroral endoscopic myotomy) 1,6,9,10.
• Achalasia and Dysphagia: For patients struggling with swallowing, Endoflip can assess the LES and esophageal body for abnormal tightness or lack of flexibility—key findings in achalasia and other motility disorders 5,7.
• Hiatal Hernia and Reflux: Measuring the distensibility of the esophagogastric junction can provide insights into reflux symptoms and the functional impact of hiatal hernias 2,8.

Guiding and Evaluating Treatment

Endoflip is not just a diagnostic tool—it’s also used during procedures to guide therapy and immediately assess results:

• Intraoperative Feedback: Surgeons use Endoflip during fundoplication, myotomy, or sphincter augmentation to ensure the desired degree of tightness or loosening is achieved 3,7,8.
• Treatment Prognosis: Measurements can predict who is most likely to benefit from interventions like G-POEM or botulinum toxin injection, allowing for tailored therapy 6,9.

Endoflip Test Details

Having a clear picture of what happens during the Endoflip test can ease anxiety and help you prepare. The procedure is minimally invasive, typically performed during an endoscopy or surgery, and provides immediate results.

How the Endoflip Test Works

The Endoflip system consists of a thin, flexible catheter with a balloon containing multiple sensors. Here’s how the test unfolds:

Preparation and Setting

• Fasting: Patients typically fast for several hours before the procedure, similar to prep for a standard endoscopy 6.
• Sedation: Most tests are done under light sedation or general anesthesia, especially if combined with another endoscopic or surgical procedure 3,7.

Insertion and Placement

• Catheter Introduction: The Endoflip catheter is gently advanced through the mouth or an existing gastrostomy tract (in children or select adults) to the target location—such as the LES or pylorus 1,6.
• Positioning: The balloon is positioned so that it straddles the sphincter or area of interest.

Balloon Inflation and Measurement

• Stepwise Inflation: The balloon is inflated in measured steps (commonly 20, 30, 40, up to 50 mL), stretching the targeted area 4,6,9,10.
• Data Capture: Embedded sensors measure:
  • Diameter
  • Cross-sectional area (CSA)
  • Pressure
  • Distensibility Index (DI): Calculated as CSA divided by pressure, reflecting how easily the area opens under pressure 1,2,5,9.
• Duration: The entire process is quick, often under 30 minutes 6,7.

Safety and Comfort

• Well-Tolerated: Most patients experience no added discomfort compared to standard endoscopy 6.
• Low Risk: Major complications are rare; Endoflip is considered safe, even in children 4,6.

What Makes Endoflip Unique?

• Real-Time, Objective Data: Unlike traditional imaging or manometry, Endoflip provides continuous, numeric feedback on the mechanical properties of GI segments 3,5.
• Surgical Integration: It can be used intraoperatively to guide and confirm the success of surgeries like fundoplication or myotomy 3,7,8.
• Adaptability: Effective in diverse populations, including children, adults, and post-surgical patients 4,6,10.

Endoflip Test Results & Follow-Up

The true value of the Endoflip test lies in how its results guide diagnosis and management. Understanding your Endoflip results helps inform the next steps in your care journey.

Interpreting Endoflip Results

• Diameter and Cross-Sectional Area (CSA): Small diameters or CSA suggest a tightly closed sphincter, which may explain symptoms like dysphagia or delayed gastric emptying 1,2,7,9.
• Pressure: Elevated pressures indicate a stiff or resistant area. For example, a high-pressure pylorus may be seen in gastroparesis 1,4.
• Distensibility Index (DI): This is the most clinically valuable measure. A low DI means the area does not expand well, which is often the culprit in motility disorders 1,4,5,10.

Example: Gastroparesis and the Pylorus

• Low Pyloric Distensibility: Strongly linked to symptoms and poor gastric emptying. Improvement in DI after interventions like G-POEM or botulinum toxin is associated with better symptom relief 1,6,9,10.
• Pediatric and Post-Surgical Use: Children with neurodisabilities and post-esophagectomy patients also benefit from Endoflip-guided assessment and therapy 4,6.

Example: Achalasia and the Esophagogastric Junction

• Low LES Distensibility: Key finding in achalasia, sometimes even when standard manometry is inconclusive 5,7.
• Post-Myotomy: Increased diameter and DI after myotomy (surgical or endoscopic) can confirm the success of the procedure 7.

Surgical Outcomes and Prognosis

• Fundoplication and Hiatal Hernia Repair: Intraoperative Endoflip measurements can help surgeons achieve the ideal balance—tight enough to prevent reflux, but not so tight as to cause swallowing problems. Optimal ranges for DI can be targeted, improving outcomes 3,8.
• Predicting Success: Higher post-treatment DI correlates with greater symptom improvement and improved gastric emptying 6,8,9.

What Happens Next?

• Guided Therapy: Results may lead to interventions such as dilation, myotomy, or injections.
• Repeat Assessment: In some cases, follow-up Endoflip tests help monitor progress or guide further therapy 3,6.
• Integration with Other Tests: Endoflip results are often used alongside manometry, imaging, and gastric emptying studies for a complete picture 1,5,9.

Conclusion

The Endoflip test is revolutionizing care for patients with complex GI conditions by adding a new dimension to diagnosis and treatment planning. Its ability to measure the real-time biomechanics of the digestive tract means doctors can tailor therapies more precisely than ever.

Key Takeaways:

• Purpose: Endoflip provides objective, real-time measurements of GI sphincter and segment function, offering essential insights for diagnosing and managing motility disorders 1,2,5,7,10.
• Test Details: The procedure is safe, quick, and well-tolerated, using a balloon-tipped catheter with embedded sensors during endoscopy or surgery 3,6,7,9.
• Results & Follow-Up: Measurements of diameter, pressure, and distensibility index guide diagnosis, predict treatment success, and inform follow-up care 1,4,5,6,8,9,10.
• Clinical Impact: Endoflip is especially valuable for patients with gastroparesis, achalasia, reflux, or post-surgical GI symptoms, as well as for intraoperative guidance and pediatric populations 1,3,4,5,6,7,8,9,10.

Understanding the Endoflip test equips patients and providers to make informed decisions and pursue the most effective treatments with confidence.