Endoscopic functional luminal imaging probe for intraprocedural guidance of achalasia treatment: a systematic review and meta-analysis
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background:
Functional luminal imaging probes (EndoFLIP) have shown potential as both diagnostic tools and intraoperative guides during achalasia interventions. This systematic review and meta-analysis aim to evaluate the intraoperative use of EndoFLIP during surgical procedures for achalasia, with a focus on its impact on the distensibility index (DI) and treatment outcomes.
Materials and methods:
A literature search of Medline, Embase, and the Cochrane Library was conducted for studies reporting the use of EndoFLIP and DI in achalasia treatment from January 2000 to January 2024. Meta-analysis was performed using random-effect models to assess treatment effects, with heterogeneity between studies evaluated.
Results:
A total of 32 studies with 2681 patients were included in the qualitative synthesis, and 17 studies with 1734 patients were included in the quantitative synthesis. A pooled random-effects analysis demonstrated a significant reduction in DI following myotomy, with a weighted mean difference (WMD) of −3.72 (95% CI: −4.16 to −3.28; I2 = 90%). The Eckardt score analysis, including data from 1009 patients, showed a significant reduction by −5.21 (95% CI: −5.8 to −4.6; P < 0.001, I2 = 89.4%). The random-effects analysis of DI pre- and post-myotomy without an endoscope demonstrated a significant increase with a WMD of −2.402 (95% CI: −3.175 to −1.6; P < 0.001, I2 = 85.6%). A larger WMD was observed with endoscope placement above the FLIP device, measuring −4.14 (95% CI: −5.4 to −2.8; P < 0.001, I2 = 91.2%). For the 30 mL balloon fill, the WMD in the DI post-myotomy was −2.89 (95% CI: −3.2 to −2.4; P < 0.001). For the 40 mL balloon fill, the WMD was −4.02 (95% CI: −4.8 to −3.1; P < 0.001).
Conclusions:
EndoFLIP enhances achalasia treatment by offering real-time feedback on the DI, allowing for more tailored interventions and improved outcomes. A standardized protocol for EndoFLIP usage is necessary to further validate its role in clinical practice and ensure consistent, comparable measurements.
Functional luminal imaging probes (EndoFLIP) have shown potential as both diagnostic tools and intraoperative guides during achalasia interventions. This systematic review and meta-analysis aim to evaluate the intraoperative use of EndoFLIP during surgical procedures for achalasia, with a focus on its impact on the distensibility index (DI) and treatment outcomes.
Materials and methods:
A literature search of Medline, Embase, and the Cochrane Library was conducted for studies reporting the use of EndoFLIP and DI in achalasia treatment from January 2000 to January 2024. Meta-analysis was performed using random-effect models to assess treatment effects, with heterogeneity between studies evaluated.
Results:
A total of 32 studies with 2681 patients were included in the qualitative synthesis, and 17 studies with 1734 patients were included in the quantitative synthesis. A pooled random-effects analysis demonstrated a significant reduction in DI following myotomy, with a weighted mean difference (WMD) of −3.72 (95% CI: −4.16 to −3.28; I2 = 90%). The Eckardt score analysis, including data from 1009 patients, showed a significant reduction by −5.21 (95% CI: −5.8 to −4.6; P < 0.001, I2 = 89.4%). The random-effects analysis of DI pre- and post-myotomy without an endoscope demonstrated a significant increase with a WMD of −2.402 (95% CI: −3.175 to −1.6; P < 0.001, I2 = 85.6%). A larger WMD was observed with endoscope placement above the FLIP device, measuring −4.14 (95% CI: −5.4 to −2.8; P < 0.001, I2 = 91.2%). For the 30 mL balloon fill, the WMD in the DI post-myotomy was −2.89 (95% CI: −3.2 to −2.4; P < 0.001). For the 40 mL balloon fill, the WMD was −4.02 (95% CI: −4.8 to −3.1; P < 0.001).
Conclusions:
EndoFLIP enhances achalasia treatment by offering real-time feedback on the DI, allowing for more tailored interventions and improved outcomes. A standardized protocol for EndoFLIP usage is necessary to further validate its role in clinical practice and ensure consistent, comparable measurements.
Date Issued
2025-07-01
Date Acceptance
2025-04-01
Citation
International Journal of Surgery, 2025, 111 (7), pp.4165-4176
ISSN
1743-9159
Publisher
Elsevier
Start Page
4165
End Page
4176
Journal / Book Title
International Journal of Surgery
Volume
111
Issue
7
Copyright Statement
Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution-ShareAlike License 4.0, which allows others to remix, tweak, and build upon the work, even for commercial purposes, as long as the author is credited and the new creations are licensed under the identical terms.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/40391946
PII: 01279778-202507000-00002
Subjects
EndoFLIP
achalasia
distensibility index
gastro-esophageal reflux disease
myotomy
Humans
Esophageal Achalasia
Treatment Outcome
Esophagoscopy
Myotomy
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2025-05-20