This SAGES-EAES systematic review and meta-analysis evaluated the diagnostic and clinical utility of the functional lumen imaging probe (FLIP/impedance planimetry) across four clinical questions: preoperative FLIP vs. high-resolution manometry (HRM) before anti-reflux surgery, intraoperative FLIP vs. standard technique during anti-reflux surgery, intraoperative FLIP vs. standard technique during myotomy, and preoperative FLIP vs. standard care before pylorus-directed therapy for gastroparesis (literature through June 24, 2025).
For achalasia screening before anti-reflux surgery, FLIP showed high sensitivity (1.00; 95% CI 0.98–1.00) but low specificity (0.52; 95% CI 0.38–0.66). Intraoperative FLIP during myotomy was associated with higher symptom resolution (OR 3.45; 95% CI 1.09–10.93), while intraoperative use during anti-reflux surgery showed little to no difference in dysphagia, reflux recurrence, gas bloating, or quality of life. No comparative data existed for gastroparesis applications.
- Overall certainty of evidence is low to very low (GRADE), based entirely on comparative observational studies with no RCTs included. - No comparative studies were identified for the gastroparesis key question, leaving this clinical area unevaluated. - Long-term outcome data for FLIP-guided decisions are limited across all clinical contexts.
FLIP is a highly sensitive but nonspecific screening tool for achalasia prior to anti-reflux surgery; it may improve outcomes when used intraoperatively during myotomy, but surgeons should not expect benefit during routine anti-reflux surgery. Given very low certainty evidence, FLIP should complement—not replace—standard workup until prospective trials clarify its role.
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