The goal of the proposed research is to evaluate the endoscopic esophageal functional luminal
imaging probe (FLIP) with topography (Endoflip® 2.0, Medtronic, USA) as a pre-operative
diagnostic test to rule out significant esophageal dysmotility in patients with
gastroesophageal reflux disease (GERD). Currently, the gold standard for pre-operative
motility assessment is high resolution manometry (HRM), a trans-nasal catheter test performed
in an awake patient that can be quite uncomfortable, and some patients cannot tolerate.1
Conversely, Endoflip can provide similar data in a sedated patient at the time of upper
endoscopy, limiting discomfort and streamlining workup. While Endoflip has been used as a
complimentary tool for clinical decision making in major motility disorders, its evaluation
as a potential stand-alone pre-operative test in the GERD population has been limited.
However, if FLIP topography reliably excludes major motility disorders, patients could
proceed with fundoplication without undergoing the additional burden of high resolution
manometry (HRM) testing. Unfortunately, as of now, there are insufficient data available to
justify a change in clinical practice. As a result, FLIP topography has remained relegated to
a purely complimentary role.
To investigate this question, the investigators will perform FLIP topography (Endoflip 2.0)
analysis on all patients undergoing routine evaluation for gastroesophageal reflux disease at
the time of their pre-operative EGD. Those patients with repetitive antegrade contractions
(RACs) on FLIP topography will be classified as having normal motility, while any other
pattern will be considered abnormal. All patients will additionally complete a standard
pre-operative reflux evaluation including HRM, Upper GI series (UGI), 48-hour wireless pH
testing, and baseline GERD quality of life surveys. The investigators will then compare the
results of the FLIP topography measurements to the results of the gold standard
high-resolution manometry (HRM) in terms of the ability of the FLIP topography to
differentiate between normal and impaired esophageal function in GERD patients. Subjects will
then be followed through their anti-reflux operations and post-operative outcomes will be
tracked with standardized symptom questionnaires at 1, 2 and 6 months post-operatively to
evaluate for post-operative dysphagia and quality of life.
The investigators hypothesize that FLIP topography (Endoflip 2.0) in GERD patients will
reliably identify individuals with normal motility, which will predict good outcomes after
anti-reflux surgery. If this proves to be the case, formal high resolution manometry (HRM)
testing would not be necessary prior to proceeding with fundoplication, allowing a paradigm
shift in the pre-operative workup of this large population of patients.