Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona
Kumar Krishnan, MD
Division of Gastroenterology, Department of Internal Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
Rabindra R. Watson, MD
Department of Gastroenterology, Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California
Marcelo F. Vela, MD, MS
Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona
Barham K. Abu Dayyeh, MD, MPH, FASGE
Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
Amit Bhatt, MD
Department of Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, Ohio
Manoop S. Bhutani, MD, FASGE
Department of Gastroenterology Hepatology and Nutrition, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
Juan Carlos Bucobo, MD, FASGE
Division of Gastroenterology and Hepatology, Stony Brook Medicine, Stony Brook, New York
Vinay Chandrasekhara, MD, FASGE
Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
Andrew P. Copland, MD
Division of Gastroenterology and Hepatology, University of Virginia Health Systems, Charlottesville, Virginia
Pichamol Jirapinyo, MD, MPH
Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts
Nikhil A. Kumta, MD, MS
Division of Gastroenterology, Mount Sinai Hospital, New York, New York
Ryan J. Law, DO
Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
John T. Maple, DO, FASGE
Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
Joshua Melson, MD, MPH, FASGE
Division of Digestive Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
Mansour A. Parsi, MD, MPH, MBA, FASGE
Division of Gastroenterology and Hepatology, University of Tennessee Health Sciences Center, Memphis, Tennessee
Erik F. Rahimi, MD
Department of Gastroenterology, Baylor Scott & White Health, Lakeway, Texas
Monica Saumoy, MD, MS
Department of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania
Amrita Sethi, MD, MASGE
Department of Digestive and Liver Diseases, New York-Presbyterian Medical Center/Columbia University Medical Center, New York, New York
Guru Trikudanathan, MBBS
Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota
Arvind J. Trindade, MD, FASGE
Department of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, New Hyde Park, New York
Julie Yang, MD, FASGE
Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
David R. Lichtenstein, MD, FASGE
Division of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
Background and Aims: Esophageal function testing is an integral component of the evaluation of refractory GERD and esophageal motility disorders. This review summarizes the current technologies available for esophageal function testing, including the functional luminal imaging probe (FLIP), high-resolution esophageal manometry (HRM), and multichannel intraluminal impedance (MII) and pH monitoring. Methods: We performed a MEDLINE, PubMed, and MAUDE database literature search to identify pertinent clinical studies through March 2021 using the following key words: esophageal manometry, HRM, esophageal impedance, FLIP, MII, and esophageal pH testing. Technical data were gathered from traditional and web-based publications, proprietary publications, and informal communications with pertinent vendors. The report was drafted, reviewed, and edited by the American Society for Gastrointestinal Endoscopy Technology Committee and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy. Results: FLIP is a high-resolution impedance planimetry system used for pressure and dimension measurement in the esophagus, pylorus, and anal sphincter. FLIP provides complementary information to HRM for esophageal motility disorders, especially achalasia. The Chicago classification, based on HRM data, is a widely adopted algorithmic scheme used to diagnose esophageal motility disorders. MII detects intraluminal bolus movement and, combined with pH measurement or manometry, provides information on acid and non-acid gastroesophageal reflux and bolus transit in patients with refractory GERD and for preoperative evaluation for anti-reflux procedures. Conclusions: Esophageal function testing techniques (FLIP, HRM, and MII-pH) have diagnostic and prognostic value in the evaluation of esophageal motility disorders and refractory GERD. Newer technologies and classification systems have enabled an increased understanding of these diseases.
