Safety and efficacy of EsoFLIP dilation in patients with esophageal dysmotility: a systematic review

Umair Iqbal; Michael Yodice; Zohaib Ahmed; Hafsa Anwar; Syeda Faiza Arif; Wade M Lee-Smith; David L Diehl

doi:10.1093/dote/doae036

Safety and efficacy of EsoFLIP dilation in patients with esophageal dysmotility: a systematic review

Dis Esophagus. 2024 Apr 24:doae036. doi: 10.1093/dote/doae036. Online ahead of print.

Authors

Umair Iqbal¹, Michael Yodice², Zohaib Ahmed³, Hafsa Anwar⁴, Syeda Faiza Arif⁵, Wade M Lee-Smith⁶, David L Diehl²

Affiliations

¹ Department of Gastroenterology and Hepatology, Wellspan York Hospital, York, PA, USA.
² Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA.
³ Department of Gastroenterology, University of Toledo Medical Center, Toledo, OH, USA.
⁴ Department of Medicine, Capital Health Regional Medical Center, Trenton, NJ, USA.
⁵ Dow University of Health Sciences, Karachi, Pakistan.
⁶ Department of University Libraries, University of Toledo Medical Center, Toledo, OH, USA.

PMID: 38659256
DOI: 10.1093/dote/doae036

Abstract

Esophageal manometry is utilized for the evaluation and classification of esophageal motility disorders. EndoFlip has been introduced as an adjunctive test to evaluate esophagogastric junction (EGJ) distensibility. Treatment options for achalasia and EGJ outflow obstruction (EGJOO) include pneumatic dilation, myotomy, and botulinum toxin. Recently, a therapeutic 30 mm hydrostatic balloon dilator (EsoFLIP, Medtronic, Minneapolis, MN, USA) has been introduced, which uses impedance planimetry technology like EndoFlip. We performed a systematic review to evaluate the safety and efficacy of EsoFLIP in the management of esophageal motility disorders. A systematic literature search was performed with Medline, Embase, Web of science, and Cochrane library databases from inception to November 2022 to identify studies utilizing EsoFLIP for management of esophageal motility disorders. Our primary outcome was clinical success, and secondary outcomes were adverse events. Eight observational studies including 222 patients met inclusion criteria. Diagnoses included achalasia (158), EGJOO (48), post-reflux surgery dysphagia (8), and achalasia-like disorder (8). All studies used 30 mm maximum balloon dilation except one which used 25 mm. The clinical success rate was 68.7%. Follow-up duration ranged from 1 week to a mean of 5.7 months. Perforation or tear occurred in four patients. EsoFLIP is a new therapeutic option for the management of achalasia and EGJOO and appears to be effective and safe. Future comparative studies with other therapeutic modalities are needed to understand its role in the management of esophageal motility disorders.

Keywords: EGJOO; EndoFlip; EsoFLIP; achalasia; systematic review.

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