Endoluminal Functional Lumen Imaging Probe in the Functional Assessment of Pyloric Sphincter in Gastroparesis: A Systematic Review With Meta‐Analysis of Normative Values
Bibliographic record
Abstract
ABSTRACT Background and Aim The aim of this systematic review and meta‐analysis was to investigate the role of EndoFLIP in gastroparesis, focusing on reference values of pyloric function and the effect of pylorus‐targeted therapies. Methods A systematic search of major databases and conference proceedings was performed up to July 2025. Observational studies and RCTs reporting FLIP measurements in confirmed gastroparesis were included. Pooled baseline values, percentile distributions, and mean differences (MDs) pre‐ versus posttreatment were calculated. Heterogeneity was addressed with random effects models, sensitivity analyses, and meta‐regression. Results Twenty‐three studies ( N = 981 patients with gastroparesis) were included. Most were prospective cohorts or single‐center studies, with G‐POEM as the predominant intervention. The most assessed FLIP metrics were distensibility index (DI) and cross‐sectional area (CSA). Three (out of 7) studies reported a positive correlation between DI and CSA with specific symptoms (dyspepsia spectrum and nausea/vomiting) and their severity at baseline. Thirteen out of 18 studies showed an association between FLIP parameters with clinical response while no robust link with gastric emptying emerged. Baseline pooled normative values at 40 mL distension were: DI 7.40 mm 2 /mmHg (5th–95th percentile: 2.5–25.4), CSA 129.6 mm 2 (51.3–249.7), D min 13.2 mm (8.2–19.1), and P 17.8 mmHg (7.7–39.2). At 50 mL: DI 5.7 mm 2 /mmHg, CSA 191.9 mm 2 , D min 16.1 mm, and P 29.9 mmHg. After pyloric‐targeted therapy, FLIP metrics improved significantly: DI increased at 40 mL (MD 3.5 mm 2 /mmHg, 95% CI 2.1–4.8; I 2 57.3%) and at 50 mL (MD 1.7 mm 2 /mmHg, 95% CI −0.7 − +4.1; I 2 61.1%); CSA increased at 40 mL (MD 42.3 mm 2 , 95% CI 30.7–53.9; I 2 13%) and 50 mL (MD 63.2 mm 2 , 95% CI 41.3–85.1; I 2 0%). Conclusions EndoFLIP provides reproducible pyloric functional metrics in gastroparesis. DI and CSA, particularly at 40–50 mL distension, are the most reliable parameters, improving consistently after pylorus‐targeted therapies and reflecting clinical benefit. A DI of < 7–10 mm 2 /mmHg may represent a pragmatic threshold for impaired distensibility and a good target for treatment response.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.034 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.019 | 0.029 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".