EndoFLIP® in real-world esophagology: a versatile tool for diagnosing and managing dysphagia across diverse clinical scenarios.

BACKGROUND

High-resolution manometry (HRM) is the gold standard for evaluating esophageal motility but may be inconclusive, poorly tolerated, or unavailable. The Endoluminal Functional Lumen Imaging Probe (EndoFLIP) provides real-time assessment of esophageal distensibility and contractility and is emerging as a complementary diagnostic modality.

AIM: To evaluate the impact of routine EndoFLIP use across diverse esophageal pathologies, particularly when HRM is inconclusive or unavailable and to contextualize findings within current evidence.

METHODS

We retrospectively analyzed 106 adults with dysphagia who underwent endoscopy with EndoFLIP (16-cm catheter). Indications included inconclusive/unavailable HRM ( n  = 27), suspected esophagogastric junction outflow obstruction (EGJOO, n  = 14), eosinophilic esophagitis (EoE, n  = 29), achalasia ( n  = 13), and postsurgical dysphagia ( n  = 23). Distensibility index, cross-sectional area, and maximal diameter were correlated with endoscopic, histologic, and clinical data.

RESULTS

EndoFLIP clarified diagnoses in 92.6% of inconclusive HRM cases and prompted management changes in 81.1% overall. Only 2/14 EGJOO patients showed reduced esophagogastric junction distensibility, avoiding unnecessary interventions in the remainder. In EoE, 86.2% exhibited reduced distensibility, leading to dilation ( n  = 6) or escalation to biologic therapy ( n  = 3). In achalasia, EndoFLIP-guided referral for peroral endoscopic myotomy or Heller myotomy enabled posttreatment assessment. In postsurgical dysphagia, reduced distensibility was detected in 45% of cases, prompting intra-procedure intervention in 44%.

CONCLUSION

EndoFLIP provides objective, real-time evaluation of esophageal mechanics, enhancing diagnostic accuracy and facilitating targeted therapy in complex or indeterminate cases. These findings, consistent with contemporary literature, support its integration into routine esophageal assessment.