During an interview with Jon O’Dea, Managing Director of Crospon, talks about the driving force behind Endoflip® and those that will directly benefit from using it.
Q: What is the driving force behind Endoflip®?
A: At its core, Endoflip® is measurement device, which uses high-resolution electrical impedance to measure the relationship between the dimensions of the gastrointestinal tract and distensive pressure, in other words, dinstensibly and compliance.
I was first introduced to the technology by Irish medical physicist Barry McMahon, who developed it while working with bioengineer and scientist Hans Gregersen in Denmark. Endoflip® is centred on electro-medical innovation, in common with Caradyne, a respiratory therapy equipment company I co-founded in 1998, which was acquired by Respironics in 2004. Immediately, I could see the potential to bring precise calibration to gastrointestinal surgery and to provide quantitative information on the mechanical properties of the full gastrointestinal tract.
Endoflip® is currently used by 50 percent of top 30 gastroenterology clinical centers in the USA, and a quarter of the remaining top 30 are on the verge of implementation. The initial applications to receive FDA approval were as a measurement tool in bariatric surgery and in upper GI surgery procedures such as laparoscopic fundoplication surgery, Heller myotomy for achalasia, and esophageal balloon dilation.
The prospective benefits for both clinicians and patients drive our team at Crospon to continue pushing out Flip® technology to new users and applications.
Q: What are those benefits?
A: Some of the benefits are nicely illustrated in a potential new use for Endoflip® in the evaluation of non-obstructive dysphagia, as described in a recent paper in the American Journal of Gastroenterology , which concluded that Flip® Topography may enhance diagnostic evaluation of non-obstructive dysphagia and identify abnormalities not appreciated on manometry.
The beauty in this application is that the Flip® study can be performed in less than five minutes during a sedated upper endoscopy. This puts information directly into the hands of endoscopists like never before. Moreover, the patient does not have to wait for testing at a specialist centre; treatment can commence immediately.
While not always a substitute for manometry, as a precursor, Endoflip® can reveal situations of non-obstructive dysphagia, for example those associated with neurological problems, which may benefit from further evaluation with manometry. In addition, it has potential applications where trans-nasal placement is poorly tolerated by the patient or is not possible due to the shape of the nasal passage.
Q: What are next developments for Endoflip®?
A: The story of Endoflip® is continually evolving. It has now been the subject of over 70 clinical papers, which clearly highlight the benefits of Flip® when assessing a range of GI disorders.
With eosinophilic esophagitis (EoE), for instance, we are seeing evidence of esophagual distensibility as a measurement of disease severity and as an objective means to measure the outcomes of medical or dilation therapy.
Meanwhile, moving up from the esophagus, there is potential to study swallow problems in stroke and Parkinson’s disease patients.
Another area I find exciting is the potential to extend topographic assessment down into the duodenum and the colon, opening up new ways of studying the effect of diseases such as Crohn’s disease and ulcerative colitis on motility and structure. Likewise, there is interest in studying the pylorus in normal rhythm gastroparetic patients and ano-rectal function in patients with constipation and incontinence. 
As well as these evolving applications, we are excited about new planned product releases moving more closely towards ‘plug and play’ data analytics, supporting the use of Endoflip® beyond specialized centres into mainstream gastroenterological practice.