Gastroenterology
precise diagnosis and treatment planning from the very first endoscopy, preventing unnecessary distress for patients.1
Comparison with other diagnostic tools When comparing Endoflip to other diagnostic tools like barium swallow and high-resolution manometry (HRM), several advantages become apparent, particularly in terms of patient comfort and diagnostic accuracy. Barium Swallow: This traditional diagnostic method involves swallowing a barium solution, which coats the oesophagus and allows for X-ray imaging. While useful for visualising structural abnormalities and the movement of barium through the oesophagus, it does not provide detailed information about muscle function or pressure.2
Additionally, the procedure
can be uncomfortable for patients and involves exposure to radiation.3 High-Resolution Manometry (HRM):
HRM was considered the gold standard for diagnosing oesophageal motility disorders. It involves passing a thin catheter through the nose into the oesophagus to measure muscle contractions and pressure along the oesophagus.4
guide more precise treatment planning. As an early adopter of Endoflip technology,
While highly effective, HRM can
be uncomfortable for patients due to the need for nasal intubation and the sensation of the catheter during the procedure.5
For example,
gagging/retching and in some cases vomiting In contrast to HRM, Endoflip is performed under sedation during an endoscopy, making it more comfortable for patients.6
Studies have
shown that this approach is better tolerated, with lower rates of discomfort and higher willingness to repeat the procedure compared to HRM.7 The solution also provides additional diagnostic information by measuring the cross-sectional area and distensibility of the oesophagus, which can be particularly useful in cases where HRM results are inconclusive.8 This capability allows for a more comprehensive assessment of oesophageal function and can
I have used this innovative device for research purposes. This advanced tool allows for precise measurement of oesophageal and gastric motility disorders by assessing distensibility, pressure, and contractility using high-resolution impedance planimetry. When an oesophageal motility disorder is suspected, the solution can be employed during the initial endoscopy to provide real-time insights into conditions such as achalasia or oesophagogastric junction outflow obstruction. By delivering immediate, actionable data, it significantly accelerates the diagnostic-to- treatment pathway, minimising delays and enhancing patient outcomes. Furthermore, its utility extends to cases where conventional investigations, such as manometry or pH studies, yield inconclusive results, offering clarity and direction for challenging diagnostic scenarios. By incorporating this technology into routine clinical practice, we can enhance our ability to diagnose and treat conditions like achalasia and gastroparesis, providing better care for our patients.1
Case report: management of sequential gastrointestinal malignancies and complications We report the clinical journey of a patient who developed early-stage oesophageal cancer, and subsequently developed significant post- operative upper gastro-intestinal symptoms that are common post-surgery. The use of EndoFLIP helped to isolate the problem, recommend treatment, and ultimately significantly improve the patient’s quality of life.
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www.clinicalservicesjournal.com I June 2025
In 2013, a 55-year-old male patient was diagnosed with colorectal cancer. Following successful treatment and a five-year surveillance period he remained cancer free. Unfortunately, on subsequent upper gastro- intestinal endoscopy there was a suspicious lesion at the gastroesophageal junction, which was confirmed as a stage 1 oesophageal adenocarcinoma. We subsequently proceeded to endoscopic mucosal resection (EMR), which demonstrated submucosal invasion. Following multidisciplinary discussion, he under an Ivor Lewis oesophagectomy in 2018. The procedure involved resection of the distal oesophagus and proximal stomach, followed by gastric pull-up reconstruction. Sixteen regional lymph nodes were excised, with one node being involved, necessitating adjuvant chemotherapy. Post-surgical recovery was complicated by gastroesophageal reflux disease (GORD), which developed as a consequence of gastroparesis. The impaired gastric emptying led to food stasis and subsequent reflux into the oesophagus, exacerbated by the absence of a functional lower oesophageal sphincter. The condition was managed with proton pump inhibitors (PPIs), but due to an inadequate response, he underwent initial treatment with pyloric balloon dilation and botulinum toxin injections, but this only provided transient relief. These complications highlighted the need for more definitive management. In 2023, due to persistent symptoms, we
recommended a gastric peroral endoscopic myotomy (G-POEM). However, precision treatment was essential, if the G-POEM was not performed with complete accuracy the patient could experience reflux of bile (given the patient’s anatomy) and dumping syndrome (when food moves too quickly from the stomach to the small intestine, causing nausea, diarrhoea, and dizziness). The Endoflip system played a crucial role in this procedure by providing real-time measurements of the pyloric sphincter’s distensibility to enable a tailored myotomy. This procedure, aimed at improving gastric emptying by permanently opening the pylorus, was successfully performed. Post-G-POEM, the patient reported significant improvement in reflux symptoms and overall quality of life, with minimal episodes of dumping syndrome.
In summary The patient’s journey underscores the vital importance of early detection, comprehensive surgical management through multidisciplinary collaboration, and the recognition of late post-surgical complications, which can be effectively investigated and managed using the
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