Table 9.

EndoFLIP for Selection of Patients for Pyloromyotomy or Pyloric Botulinum Toxin Injection

Patients	Measurement	Results	Reference
21 HC, 27 patients with gastroparesis and 5 patients with esophagectomy	Fasting pyloric pressure and compliance	Fasting pyloric compliance 25.2±2.4 mm/mmHg in HV, 16.9±2.1 mm/mmHg in gastroparesis (P <0.05) and 10.9±2.9 mm/mmHg in patients with esophagectomy (; P <0.05). Pyloric dilation in 10 gastroparesis patients with low fasting pyloric compliance increased compliance from 7.4±0.4 to 20.1±4.9 mm/mmHg (P <0.01) and improved the GIQLI score.	Gourcerol 2015, ref. 155
54 patients (39 IG, 15 DG)	Fasting pyloric diameter, CSA, pressure, length, DI	Wide range seen in diameter (5.6–22.1 mm) and distensibility (1–55 mm2/mmHg) of the pylorus. Symptoms of early satiety and postprandial fullness were inversely correlated with pyloric sphincter diameter and CSA.	Malik 2015, ref. 156
47 DG patients and 67 IG patients with nausea and vomiting	Sleeve manometry and EndoFLIP performed sequentially during the same endoscopy	Basal pyloric pressure was elevated (>10 mmHg) in 34 patients (42% of patients with delayed emptying); significant decrease in distensibility in patients with gastric retention (>20% at 4 h) compared with patients with normal gastric retention (<10%).	Snape 2016, ref. 157
30 IG patients and 14 DG patients	Fasting pyloric diameter, CSA, and DI	Greater gastric retention tended to correlate with decreased CSA and pyloric DI. Greater pyloric compliance at baseline correlated with greater improvement in early satiety and nausea at 8 weeks and greater pyloric DI correlated with improvement in upper abdominal pain.	Saadi 2018, ref. 158
37 patients with refractory gastroparesis	Fasting CSA, balloon pressure, and DI	Post-G-POEM CSA and DI were significantly higher in the clinical success group and improvement in gastric emptying.	Vosoughi 2020, ref. 159
20 patients with refractory gastroparesis	Fasting pyloric diameter and DI before and after G-POEM	G-POEM increased mean and maximum pyloric diameters and mean and maximum pyloric DI on 50 mL EndoFLIP inflation; therapy enhances pyloric opening but may not impair pyloric closure. The clinical success of G-POEM using EndoFLIP inflated to 50mL had specificity of 100% and sensitivity of 72.2% (area under the curve 0.72) at a distensibility threshold of 9.2 mm2/mmHg.	Watts 2020, ref. 160
35 patients with gastroparesis: 11 DG, 6 PSG, 17 IG	Fasting pyloric diameter and distensibility before BOTOX	19/35 patients with reduced (<10 mm2/mm Hg) pyloric distensibility) had benefits: TSS decreased at 3 months and gastric fullness, bloating and GIQLI score and gastric emptying T1/2 all improved; no such benefit in those with normal distensibility.	Desprez 2019, ref. 161

(CSA=cross-sectional area; DI =distensibility index; DG=diabetic gastroparesis; GIQLI=Gastrointestinal Quality of Life Index; HC=healthy controls; IG=idiopathic gastroparesis; NA=not available; PSG=post-surgical gastroparesis; TSS=total symptom score