Diagnostic Testing for Digestive Conditions

The EndoFLIP system is a balloon device that is passed transorally during an endoscopic procedure. The EndoFLIP uses impedance planimetry to measure the diameter and pressure in the esophagus at different inflation levels of the balloon. This system provides information when the esophagus is stretched and simulating a bolus to assess distensibility of the esophagus and also provides information on secondary peristalsis.

This information complements traditional testing with high-resolution manometry and barium swallows for diagnostic assessments and can be used to gauge the effect of treatments during interventions in real time during endoscopic procedures.

Sometimes other tests are not able to provide enough detail to diagnose diseases of the digestive tract and surrounding organs. Your provider may refer you for an endoscopic ultrasound, or EUS, to diagnose, evaluate or treat digestive tract conditions.

Using endoscopic ultrasound, physicians can now see beyond the inside surface of the digestive tract in more detail and can make highly accurate images of organs that lie next to the digestive tract such as the heart, lungs, liver, spleen, pancreas, gallbladder, bile ducts and prostate gland.

A specialized endoscopy technique to help visualize and study the ducts (drainage tubes) of the gallbladder, bile ducts, pancreas and liver. An endoscope (a flexible thin tube that allows the physician to see inside the digestive tract) is passed through the mouth into the duodenum (the first part of the small intestine).

The opening called the major ampulla that drains both the bile and pancreatic ducts is then identified and a small catheter (narrow plastic tube) is passed through the endoscope into the ducts. Contrast material is then injected into the ducts and X-ray images can be viewed and studied for abnormalities.

Esophageal manometry allows physicians to measure the strength and function of muscles in the esophagus and diagnose conditions that cause gastroesophageal reflux disease and swallowing disorders.

Liver biopsy is a procedure in which a doctor uses a special needle to remove a small piece of liver so it can be examined with a microscope. This is done to check for signs of damage or to diagnose the cause of liver damage.

A paracentesis is a procedure to take out fluid that has collected in the belly, called ascites. The fluid is taken out using a thin needle. The fluid is sent to a lab and studied to find the cause of fluid buildup. Paracentesis also may be done to take the fluid out to relieve belly pressure or pain in people with cancer or cirrhosis of the liver.​

Wireless pH testing

Wireless pH testing is used to evaluate the acid exposure in your esophagus while patients continue normal activities. During an upper endoscopic procedure, the physician places a small capsule in the lower esophagus. The capsule records activity in that area for over a 48-hour period or 96-hour period and transmits acid levels to a wireless recording device, which is worn on a belt.

Catheter-based pH testing

This pH study is an outpatient, transnasal catheter-based test that measures the amount of acid exposure in the esophagus. Options include with impedance testing and with upper sensors to evaluate for evidence of laryngopharyngeal reflux (LPR). Indications include an uncertainty in diagnosis of GERD, evidence to establish a GERD or LPR diagnosis, or determine adequacy of therapy.

Options for catheter-based pH testing

• 24-hour monitoring of pH alone
• 24-hour monitoring of pH with Impedance Impedance can determine antegrade and retrograde bolus transit in the esophagus. It can be used to detect GERD not responding to PPI and to determine the contribution of acidic, weakly acidic and non-acidic reflux in the setting of symptoms.
• 24-hour monitoring of pH with LPR and Impedance Upper sensors in the proximal esophagus at or just below the upper esophageal sphincter can assess evidence for reflux that may be contributing laryngopharyngeal reflux. This is particularly useful in assessing LPR and other extra-esophageal manifestations of GERD.

pH testing on or off therapy

• Off therapy Testing off therapy is often recommended for patients in whom there is a low index of suspicion for reflux disease and in evaluation for an anti-reflux procedure to document the presence of acid reflux. We recommend avoidance of PPI therapy for at least seven days and H2 blocker therapy for at least two days prior to testing.
• On therapy Testing on therapy is often recommended for patients with refractory reflux symptoms to evaluate adequacy of therapy.