Jiang Y, Vazquez-Reyes R, Kamal A, Zikos T, Triadafilopoulos G, Clarke JO. Functional lumen imaging probe use in a high-volume practice: Practical and technical implications. World J Gastrointest Endosc 2024; 16(7): 396-405 [PMID: 39072247 DOI: 10.4253/wjge.v16.i7.396]
Corresponding Author of This Article
Yan Jiang, MD, MS, Assistant Professor, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway Pavilion, GI Suite, Redwood, CA 94063, United States. yjiang24@stanford.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Jul 16, 2024; 16(7): 396-405 Published online Jul 16, 2024. doi: 10.4253/wjge.v16.i7.396
Functional lumen imaging probe use in a high-volume practice: Practical and technical implications
Yan Jiang, Raul Vazquez-Reyes, Afrin Kamal, Thomas Zikos, George Triadafilopoulos, John O Clarke
Yan Jiang, Raul Vazquez-Reyes, Afrin Kamal, Thomas Zikos, George Triadafilopoulos, John O Clarke, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood, CA 94063, United States
Author contributions: Jiang Y contributed to study design, data collection, analysis, interpretation and drafting of the manuscript; Vazquez-Reyes R contributed to data collection; Kamal A, Zikos T, and Triadafilopoulos G contributed to data interpretation and critical revision of the manuscript; Clarke JO was involved in study design, data analysis, interpretation, revision of the manuscript and study supervision. All authors have read and approve the final manuscript.
Institutional review board statement: The study was approved by the Stanford University IRB: 53329.
Informed consent statement: This research study is a retrospective study that does not discuss individual patients.
Conflict-of-interest statement: Authors have no conflicts of interest to disclose.
Data sharing statement: Data analysis methods and files are available by request to the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan Jiang, MD, MS, Assistant Professor, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway Pavilion, GI Suite, Redwood, CA 94063, United States. yjiang24@stanford.edu
Received: February 27, 2024 Revised: May 17, 2024 Accepted: June 13, 2024 Published online: July 16, 2024 Processing time: 132 Days and 8 Hours
Abstract
BACKGROUND
The functional lumen imaging probe (FLIP) is a Food and Drug Administration approved tool to aid the diagnosis and management of esophageal disorders. However, widespread adoption of FLIP remains limited and its utility in high-volume practices remains unclear.
AIM
To analyze large sample data on clinical use of FLIP and provide insight on several technical aspects when performing FLIP.
METHODS
We conducted a retrospective comparative and descriptive analysis of FLIP procedures performed by a single provider at an academic medical center. There was a total of 398 FLIP procedures identified. Patient medical records were reviewed and data regarding demographics and procedural details were collected. Statistical tests, including chi-squared, t-test, and multivariable logistic and linear regression, were performed.
RESULTS
There was an increase in FLIP cases with each successive time period of 13 months (n = 68, 146, 184, respectively) with notable rises specifically for indications of dysphagia and gastroesophageal reflux disease. There was a shift toward use of the longer FLIP balloon catheter for diagnostic purposes (overall 70.4% vs 29.6%, P < 0.01). Many cases (42.8%) were performed in conjunction with other diagnostics/interventions, such as dilation and wireless pH probe placement. Procedures were nearly equally performed with anesthesia vs moderate sedation (51.4% anesthesia), with no major complications. Patients who had anesthesia were less likely to have recurrent antegrade contractions [odds ratio (OR) = 0.4, 95%CI: 0.3-0.8] and were also more likely to have absent contractility (OR = 2.4, 95%CI: 1.3-4.4).
CONCLUSION
FLIP cases have increased in our practice with expanding indications for its use. Given limited normative data, providers should be aware of several potential technical issues, including the possible impact of sedation choice when assessing esophageal motility patterns.
Core Tip: In this study, we provide both a large sample analysis on functional lumen imaging probe (FLIP) use in our practice and data on several potential technical matters. There has been an increase in FLIP utilization in our practice over time, often paired in conjunction with other diagnostics/interventions such as dilation and/or pH probe placement. Patients who had anesthesia compared to moderate sedation were less likely to have repetitive antegrade contractions and more likely to have absent contractility. Given limited normative data, providers should be aware of these potential issues, including the possible impact of sedation choice when assessing esophageal motility patterns.
