ArticleSurgical endoscopy2021
Using a standardized intra-operative endoflip protocol during fundoplication to identify factors that affect distensibility.
Article in Surgical endoscopy, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 21 citations in OpenAlex.
- Achieving physiologic distensibility targets frequently requires modification of standard cruroplasty during anti-reflux surgery.Surgical endoscopy · 2026Article
- Use of intraoperative distensibility index with EndoFLIP™ is independently associated with hiatal hernia recurrence after fundoplication.Surgical endoscopy · 2026Article
- Development of expert consensus protocols for diagnostic and procedural use of the EndoFLIP system.Surgical endoscopy · 2026Article
- Sleeve Gastrectomy Leads to Immediate, Significant Intraoperative Increase in Lower Esophageal Distensibility and Opening Area.Journal of clinical medicine · 2026Article
- Functional Lumen Imaging Probe Measurement Post-Pneumatic Dilation in Clinically Relevant Esophagogastric Junction Outlet Obstruction.Neurogastroenterology and motility · 2025Article
- Does the use of EndoFLIP during fundoplications improve outcomes?Surgical endoscopy · 2025Article
- Distensibility index measured after Toupet fundoplication is associated with long-term dysphagia.Surgical endoscopy · 2025Article
- Target distensibility index on impedance planimetry during fundoplication by choice of wrap and choice of bougie.Surgical endoscopy · 2023Article
- Use of endolumenal functional lumen imaging probe in investigating paediatric gastrointestinal motility disorders.World journal of clinical pediatrics · 2023Review
- Outcomes after anti-reflux procedures: Nissen, Toupet, magnetic sphincter augmentation or anti-reflux mucosectomy?Surgical endoscopy · 2023Article
- A novel EndoFLIP marker during hiatal hernia repair is associated with short-term postoperative dysphagia.Surgical endoscopy · 2022Article
- Impedance Planimetry (Endoflip™) Shows That Length of Narrowing After Fundoplication Does Not Impact Dysphagia.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2022Article
Corrections and comments
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Authors and funding
10 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe Endoluminal Functional Lumen Imaging Probe (Endoflip) can be used to provide objective measurements of the gastroesophageal junction during fundoplication, and recent publications have suggested that this device could improve surgical outcomes. However, the impact of operative variables has not been clearly reported. The aim of this study is to determine the effect of these variables on functional lumen imaging probe (FLIP) measurements.
methodsFollowing implementation of a standardized operative FLIP protocol, all data were collected prospectively and entered into a quality database. This database was queried for patients undergoing hiatal hernia repair and fundoplication. The protocol utilized various balloon volumes (30 and 40 ml), patient positions (flat and reverse Trendelenburg) and amounts of insufflation (15 mmHg pneumoperitoneum and no pneumoperitoneum).
resultsBetween August 2018 and February 2020, 97 fundoplications were performed by a single surgeon. Multivariable analysis without interactions demonstrated that a 40 ml volume fill resulted in significantly higher minimum diameter (Dmin), cross-sectional area (CSA), intra-balloon pressure (IBP) and distensibility index (DI) compared to a 30 ml volume fill (p < 0.001). While reverse Trendelenburg positioning resulted in a significantly higher Dmin, IBP and CSA compared to the flat position (all p < 0.05), there was little impact of positioning on DI. Lastly, pneumoperitoneum significantly increased IBP (p < 0.001) but did not affect Dmin (p = 0.697) or CSA (p = 0.757), which resulted in a significant decrease in DI (p < 0.001) when compared to measurements without pneumoperitoneum. Multivariable analysis allowing for interactions demonstrated significant two-way interactions between balloon volume and pneumoperitoneum (p = 0.047), as well as patient position and pneumoperitoneum (p < 0.001).
conclusionSurgeons should consider balloon volume and the presence or absence of pneumoperitoneum when interpreting distensibility during or after fundoplication. Additionally, we suggest a formal standardized protocol for FLIP measurements to utilize a 40 ml volume fill in reverse Trendelenburg without pneumoperitoneum.
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