{"id":4787,"date":"2020-07-24T09:23:15","date_gmt":"2020-07-24T09:23:15","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/uncategorized\/endoluminal-functional-lumen-imaging-probe-endofliptm-conhecendo-tecnologia-e-seus-potenciais-usos\/"},"modified":"2022-06-17T13:45:54","modified_gmt":"2022-06-17T13:45:54","slug":"endoluminal-functional-lumen-imaging-probe-endofliptm-conhecendo-tecnologia-e-seus-potenciais-usos","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/endoluminal-functional-lumen-imaging-probe-endofliptm-conhecendo-tecnologia-e-seus-potenciais-usos\/","title":{"rendered":"Endoluminal Functional Lumen Imaging Probe (EndoflipTM): conhecendo a tecnologia e seus potenciais usos"},"content":{"rendered":"

O EndoflipTM <\/sup>\u00e9 uma t\u00e9cnica inovadora que utiliza a tecnologia de planimetria por imped\u00e2ncia para avaliar a distensibilidade<\/strong> de \u00f3rg\u00e3os gastrointestinais.<\/p>\n

Apesar de desenvolvido em 2009, o seu uso ainda \u00e9 restrito a ambientes de pesquisa devido ao custo elevado e \u00e0 necessidade de maiores evid\u00eancias para melhor padroniza\u00e7\u00e3o do m\u00e9todo.<\/p>\n

Consiste de um cateter que apresenta em sua extremidade distal um bal\u00e3o distens\u00edvel de 8 ou 16 cm (Figuras 1 e 2). Neste bal\u00e3o, est\u00e3o localizados 16 pares de sensores de planimetria por imped\u00e2ncia, que s\u00e3o capazes de medir a \u00e1rea de sec\u00e7\u00e3o transversal de um plano do \u00f3rg\u00e3o (planimetria) utilizando a resist\u00eancia el\u00e9trica (imped\u00e2ncia) do fluido existente no bal\u00e3o.<\/p>\n

Na extremidade distal do cateter, est\u00e1 localizado ainda um transdutor de press\u00e3o, que \u00e9 respons\u00e1vel por aferir a press\u00e3o dentro do bal\u00e3o. Desta forma, dividindo-se a \u00e1rea transversal pela press\u00e3o, podemos determinar o \u00cdndice de Distensibilidade<\/strong> em reposta \u00e0 distens\u00e3o controlada por volume.<\/p>\n

\"\"

Figura 1: Representa\u00e7\u00e3o do monitor do EndoflipTM (Su B et al, 2020).<\/p><\/div>\n

\"representacao-do-cateter-e-endofliptm.jpg\"

Figura 2: Representa\u00e7\u00e3o do cateter EndoflipTM realizando medidas em esf\u00edncter inferior do es\u00f4fago (Hirano et al, 2017).<\/p><\/div>\n

A grande parte dos estudos com o EndoflipTM <\/sup>foi realizada para avalia\u00e7\u00e3o esof\u00e1gica. Para tal, o cateter \u00e9 introduzido com o paciente sedado, geralmente ap\u00f3s a endoscopia digestiva alta.<\/p>\n

Com a introdu\u00e7\u00e3o do EndoflipTM<\/sup> 2.0 em 2017, foi associado ainda um sistema de topografia, que permite avaliar a motilidade esof\u00e1gica (se aus\u00eancia de ondas, se contra\u00e7\u00f5es anormais retr\u00f3gradas ou contra\u00e7\u00f5es normais anter\u00f3gradas) \u2013 Figura 3.<\/p>\n

\"Figura

Figura 3: Exame sem altera\u00e7\u00f5es, apresentando jun\u00e7\u00e3o esofagog\u00e1strica com distensibilidade normal e contra\u00e7\u00f5es normais anter\u00f3gradas (Dorsey YC et al, 2020).<\/p><\/div>\n

<\/h4>\n

As potenciais aplica\u00e7\u00f5es do m\u00e9todo s\u00e3o:<\/strong><\/h2>\n

 <\/p>\n

    \n
  1. \n

    Avalia\u00e7\u00e3o de disfagia e acal\u00e1sia<\/strong><\/h3>\n<\/li>\n<\/ol>\n
      \n
    • Destaque naqueles pacientes com cl\u00ednica suspeita de acal\u00e1sia, mas d\u00favida diagn\u00f3stico devido relaxamento normal da jun\u00e7\u00e3o esofagog\u00e1strica (JEG) em exame de manometria;<\/li>\n
    • Utilidade em pacientes que n\u00e3o conseguem realizar a manometria por n\u00e3o tolerarem o desconforto da sonda (o EndoflipTM<\/sup> \u00e9 realizado sedado);<\/li>\n
    • \u00cdndice de distensibilidadeda JEG > 3 mm2<\/sup>\/mmHg e contra\u00e7\u00f5es anter\u00f3gradas sugerem normalidade (Figura 3);<\/li>\n
    • \u00cdndice de distensibilidade\u00a3 1.6 mm2<\/sup>\/mmHg da JEG, bem como aus\u00eancia de contra\u00e7\u00f5es (figura 4) ou contra\u00e7\u00f5es repetitivas retr\u00f3gradas (figura 5) sugerem acal\u00e1sia.<\/li>\n
    • Nos casos de diagn\u00f3stico manom\u00e9trico de obstru\u00e7\u00e3o ao fluxo da JEG, o \u00cdndice de Distensibilidade da JEG < 2 mm2<\/sup>\/mmHg \u00e9 associado a melhor resposta sintom\u00e1tica a terapias similares \u00e0 da acal\u00e1sia, enquanto valores > 3 mm2<\/sup>\/mmHg s\u00e3o favor\u00e1veis ao seguimento conservador.<\/li>\n<\/ul>\n
      \"Figura

      Figura 4: Jun\u00e7\u00e3o esofagog\u00e1strica com distensibilidade reduzida e aus\u00eancia de contra\u00e7\u00f5es, sugerindo Acal\u00e1sia tipo I (Dorsey YC et al, 2020).<\/p><\/div>\n

      \"juncao-esofagogastrica-com-distensibilidade-reduzida-acalasia-tipo-3.jpg\"

      Figura 5: Jun\u00e7\u00e3o esofagog\u00e1strica com distensibilidade reduzida e contra\u00e7\u00f5es repetitivas retr\u00f3gradas, sugerindo Acal\u00e1sia tipo III (Dorsey YC et al, 2020).<\/p><\/div>\n

      2. Uso intra-operat\u00f3rio para guiar ajustes em miotomias e fundoplicaturas<\/strong><\/h3>\n
        \n
      • Em miotomias, valores de \u00cdndice de Distensibilidade da JEG entre 4.5 e 8.5 mm2<\/sup>\/mmHg sugerem melhores resultados (Figura 6);<\/li>\n
      • Em fundoplicaturas, valores de \u00cdndice de Distensibilidade da JEG entre 2 e 3.5 mm2<\/sup>\/mmHg foram associadas com menor \u00edndice de disfagia e de refluxo ap\u00f3s procedimento.<\/li>\n<\/ul>\n
        \"Figura

        Figura 6: \u00cdndice de distensibilidade da Jun\u00e7\u00e3o esofagog\u00e1strica antes e ap\u00f3s miotomia em paciente com acal\u00e1sia (Su B et al, 2020)<\/p><\/div>\n

        3. Avalia\u00e7\u00e3o na esofagite eosinof\u00edlica<\/strong><\/h3>\n
          \n
        • Identificar a distensibilidade esof\u00e1gica, de modo a identificar estreitamentos fibroesten\u00f3ticos que nem sempre s\u00e3o bem avaliados pela endoscopia.<\/li>\n
        • Potencial benef\u00edcio em pacientes que persistem com disfagia a despeito da remiss\u00e3o histol\u00f3gica, podendo guiar poss\u00edveis dilata\u00e7\u00f5es.<\/li>\n<\/ul>\n

           <\/p>\n

          4. Outros potenciais usos<\/strong><\/h3>\n
            \n
          • Avaliar distensibilidade do piloro em pacientes com suspeita de gastroparesia<\/li>\n
          • Avaliar canal anal em pacientes com incontin\u00eancia.<\/li>\n<\/ul>\n

             <\/p>\n

             <\/p>\n

            REFER\u00caNCIAS<\/strong><\/h5>\n

            [1]      Dorsey YC, Posner S, Patel A. Esophageal Functional Lumen Imaging Probe (FLIP): How Can FLIP Enhance Your Clinical Practice? Dig Dis Sci 2020. Online ahead of print. doi:10.1007\/s10620-020-06443-8.<\/p>\n

            [2]      Hirano I, Pandolfino JE, Boeckxstaens GE. Functional Lumen Imaging Probe for the Management of Esophageal Disorders: Expert Review From the Clinical Practice Updates Committee of the AGA Institute. Clin Gastroenterol Hepatol 2017;15:325\u201334. doi:10.1016\/j.cgh.2016.10.022.<\/p>\n

            [3]      Su B, Novak S, Callahan ZM, Kuchta K, Carbray JA, Ujiki MB. Using impedance planimetry (EndoFLIPTM<\/sup>) in the operating room to assess gastroesophageal junction distensibility and predict patient outcomes following fundoplication. Surg Endosc 2020;34:1761\u20138. doi:10.1007\/s00464-019-06925-5.<\/p>\n

            [4]      Su B, Dunst C, Gould J, Jobe B, Severson P, Newhams K, et al. Experience-based expert consensus on the intra-operative usage of the endoflip impedance planimetry system. Surg Endosc 2020. doi:10.1007\/s00464-020-07704-3.<\/p>\n

             <\/p>\n

             <\/p>\n","protected":false},"excerpt":{"rendered":"

            O EndoflipTM \u00e9 uma t\u00e9cnica inovadora que utiliza a tecnologia de planimetria por imped\u00e2ncia para…<\/p>\n","protected":false},"author":4158,"featured_media":7959,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[],"ano":[146],"tipo":[159],"volume":[147],"class_list":["post-4787","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assuntosgerais","ano-146","tipo-outros","volume-volume-ii"],"yoast_head":"\nEndoluminal Functional Lumen Imaging Probe (EndoflipTM): conhecendo a tecnologia e seus potenciais usos • Endoscopia Terapeutica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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