The Dallas Consensus for performing and interpreting functional lumen imaging probe panometry: what it means for the clinician

PURPOSE OF REVIEW: Functional lumen imaging probe (FLIP) panometry is being increasingly used to evaluate esophageal motility at the time of endoscopy. This review explains how the recently published Dallas Consensus provides a standardized approach to FLIP protocol and interpretation with an updated motility classification scheme. RECENT FINDINGS: Performing a high quality upper endoscopy is paramount to optimally interpreting FLIP findings as it allows for exclusion of mechanical obstruction, which can contribute to abnormal FLIP findings. A normal FLIP classification with normal esophagogastric junction (EGJ) opening and normal contractile response makes a major motility unlikely, whereas a reduced EGJ opening with diminished or contractile response patterns makes an EGJ obstruction disorder such as achalasia or esophagogastric junction outflow obstruction likely on high resolution manometry (HRM). Findings of spastic contractile response or an indeterminant EGJ opening on FLIP may require further testing with HRM and/or timed barium esophagram with tablet. SUMMARY: Performing FLIP during endoscopy using the Dallas Consensus motility classification can help exclude or confirm an esophageal motility disorder with the potential to expedite the diagnostic workup and management for patients with esophageal symptoms.