Masterclass: Advanced GI Endoscopic Imaging (Live/Virtual) | December 2025-Konda

Konda - Esophageal motility with FLIP Panometry

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This presentation by Dr. Vani J.A. Konda focuses on esophageal motility disorders and their assessment using the Functional Luminal Imaging Probe (FLIP) Panometry. Esophageal disorders often present with overlapping symptoms such as dysphagia, food impactions, regurgitation, chest pain, and heartburn, which frequently mimic gastroesophageal reflux disease (GERD). Misdiagnosis as GERD is common and leads to treatment delays for conditions like achalasia, a primary esophageal motor disorder characterized by impaired lower esophageal sphincter (LES) relaxation and esophageal aperistalsis.<br /><br />Traditional diagnostic tools include upper endoscopy (to assess structural and inflammatory abnormalities), timed barium esophagram (to detect esophageal emptying and obstruction), and high-resolution manometry (HRM), the gold standard for diagnosing achalasia and other motility disorders. The Chicago Classification version 4.0 standardizes HRM interpretation with increased protocol rigor.<br /><br />FLIP Panometry offers a novel approach by using a balloon catheter with impedance planimetry to evaluate esophageal distensibility, diameter, and contractile function during sedation, simulating a food bolus. The latest Dallas Consensus provides standardized FLIP Panometry protocols and classification schemes to categorize motility patterns, integrating contractile response and esophagogastric junction (EGJ) opening metrics to yield a motility impression.<br /><br />FLIP complements HRM by confirming diagnoses, especially for achalasia and esophagogastric junction outflow obstruction (EGJOO), and can be used intraoperatively and for post-treatment assessment. The combined use of FLIP and endoscopic scoring (CARS score) improves diagnostic accuracy and can expedite diagnosis. The diagnostic algorithm for esophageal symptoms incorporates history, endoscopy, HRM, FLIP, and imaging to fully evaluate motility disorders.<br /><br />In conclusion, esophageal motility disorders are often challenging to diagnose due to nonspecific symptoms and overlap with GERD. Multi-modal assessment, including FLIP Panometry, can enhance detection, characterization, and management of these disorders, enabling more timely and accurate diagnosis and therapy.

Keywords

Esophageal motility disorders

Functional Luminal Imaging Probe

FLIP Panometry

Achalasia

High-resolution manometry

Chicago Classification v4.0

Esophagogastric junction outflow obstruction

Dallas Consensus

Esophageal distensibility

CARS score