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Experience-based expert consensus on the intra-operative usage of the Endoflip impedance planimetry system

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Abstract

Introduction

The Endoluminal Functional Lumen Imaging Probe (Endoflip™) is a balloon-based catheter that provides real-time, objective feedback regarding the distensibility of any sphincter in the gastrointestinal tract. Usage of the Functional Lumen Imaging Probe (FLIP) has not been standardized, which has limited the interpretation and generalizability of published data. The purpose of this consensus statement is to provide a standardized protocol for obtaining FLIP measurements in order to create a more uniform approach to data collection.

Methods

Five expert foregut surgeons, all of whom utilize the FLIP system in their daily practice, convened on March 19, 2019, to create a standardized protocol for obtaining FLIP measurements during hiatal hernia repair and fundoplication, magnetic sphincter augmentation, laparoscopic Heller myotomy, and peroral endoscopic myotomy. Existing literature was presented and reviewed. Each step of the protocol was discussed in detail until a unanimous consensus was reached.

Results

A standardized protocol was developed for obtaining FLIP measurements during hiatal hernia repair and fundoplication, magnetic sphincter augmentation, laparoscopic Heller myotomy, and peroral endoscopic myotomy.

Conclusion

The FLIP impedance planimetry system is the only technology available that provides surgeons an objective way to assess the tightness of a fundoplication or adequacy of a myotomy during an operation. While considerable research remains to correlate FLIP measurements to patient outcomes, this consensus statement will provide standardization of data collection among FLIP users that will enhance the understanding of future study results.

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Acknowledgment

The authors would like to thank Harry Wong for providing the illustrations for Figs. 1 and 2.

Funding

Medtronic provided logistical support for the meeting of this expert consensus panel. Members of Medtronic were present during the meeting, but uninvolved in the development of the consensus statement or creation of this manuscript.

Author information

Authors and Affiliations

  1. Department of Surgery, Northshore University HealthSystem, GCSI Suite B665, 2650 Ridge Ave, Evanston, IL, 60201, USA

    Bailey Su & Michael Ujiki

  2. Department of Surgery, University of Chicago, Chicago, IL, USA

    Bailey Su

  3. Department of Surgery, The Oregon Clinic, Portland, OR, USA

    Christy Dunst

  4. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Jon Gould

  5. Esophageal and Lung Institute, Allegheny Health Network, Pittsburgh, PA, USA

    Blair Jobe & Kirsten Newhams

  6. Minnesota Institute for Minimally Invasive Surgery, Cuyuna Regional Medical Center, Crosby, MN, USA

    Paul Severson & Aaron Sachs

Authors
  1. Bailey Su
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  2. Christy Dunst
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  3. Jon Gould
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  4. Blair Jobe
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  5. Paul Severson
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  6. Kirsten Newhams
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  7. Aaron Sachs
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  8. Michael Ujiki
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Corresponding author

Correspondence to Bailey Su.

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Disclosures

Dr. Jon Gould is a consultant for Ethicon and a speaker for Gore Medical. Dr. Blair Jobe is a consultant for Ethicon. Dr. Paul Severson is a consultant and speaker for Mauna Kea Technologies, a consultant for DyaMX, a speaker for Ethicon, and a St. Jude Preceptor for Abbott Pharmaceuticals. Dr. Michael Ujiki is a speaker for Medtronic, a consultant for Olympus, a scientific advisory board member for Boston Scientific, a consultant and speaker for Apollo Medical Devices, and a speaker for Gore Medical. Drs. Bailey Su, Christy Dunst, Kirsten Newhams, and Aaron Sachs have no conflicts of interest or financial ties to disclose.

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Su, B., Dunst, C., Gould, J. et al. Experience-based expert consensus on the intra-operative usage of the Endoflip impedance planimetry system. Surg Endosc 35, 2731–2742 (2021). https://doi.org/10.1007/s00464-020-07704-3

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  • DOI: https://doi.org/10.1007/s00464-020-07704-3

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