Functional lumen imaging probe in the functional assessment of pyloric sphincter in gastroparesis: a systematic review with meta-analysis of normative values

Aims The selection of the optimal patient to undergo invasive treatments is one of the major challenges in refractory gastroparesis. The aim of this systematic review was to investigate the role of FLIP in gastroparesis. Meta analysis of normative values and treatment comparative outcomes was also performed.

Methods A systematic search was performed until May 2024 on 3 major databases. Studies on post-oncological/bariatric surgery gastroparesis were excluded. Pooled baseline mean of FLIP metrics and mean differences (MDs) pre vs post-treatment were calculated to provide normative values and to assess treatment effect. Random effects meta-analysis with I² statistics and subgroup analysis to address heterogeneity were performed.

Results Twenty studies (N=805 patients) were included. The majority focused on treatment response, particularly pyloromyotomy (GPOEM). The most assessed FLIP metrics were distensibility index (DI) and cross-sectional area (CSA). Three studies reported a positive correlation between DI and CSA with specific symptoms (dyspepsia spectrum and nausea/vomiting) and their severity at baseline. Ten studies showed an association between FLIP parameters with clinical response but not with gastric emptying. Baseline DI at 30 mL (7.5 mm²/mmHg; I² 38%) and CSA at 30 mL (85.5 mm²; I² 0%) yielded the lowest heterogeneity. Comparing pre- and post-treatment response, MD of 2.5 mm²/mmHg (I² 24%) for DI at 50 mL, 46.7 mm² (I² 47%) and 68.8 mm² (I² 0%) for CSA at 40 and 50 mL respectively, resulted statistically significant.

Conclusions This is the first systematic effort in gathering evidence on FLIP in gastroparesis. CSA and DI significantly changed after pylorus-targeted treatments. Normative values displayed substantial heterogeneity. Further studies to develop and validate models of response prediction are warranted before implementing this technique in routine clinical care.

 

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Conflicts of Interest

MG has received consulting or speaking fees from Sanofi/Regeneron, Takeda, AstraZeneca and AVIR Pharma. EV received speaker and/or consulting fees from Sanofi/Regeneron, Dr Falk Pharma, Aurora Biofarma, Apollo Therapeutics. SD has served as a speaker, consultant, and advisory board member for Schering-Plough, AbbVie, Actelion, Alphawasserman, AstraZeneca, Cellerix, Cosmo Pharmaceuticals, Ferring, Genentech, Grunenthal, Johnson and Johnson, Millenium Takeda, MSD, Nikkiso Europe GmbH, Novo Nordisk, Nycomed, Pfizer, Pharmacosmos, UCB Pharma and Vifor. AJB received research funding from Nutricia, Thelial, Sanofi/Regeneron, SST, and Dr. Falk Pharma and received speaker and/or consulting fees from Laborie, Medtronic, BMS, Dr. Falk Pharma, Calypso Biotech, Eupraxia, Aqilion, Alimentiv, Sanofi/Regeneron, Reckitt and AstraZeneca

Publication History

Article published online:
27 March 2025