{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T14:06:47Z","timestamp":1780063607257,"version":"3.54.0"},"reference-count":37,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>A subgroup of treated achalasia patients has recurrent symptoms which prompt consideration of additional treatment. The aim of this study was to examine the additional yield of functional lumen imaging probe (FLIP) to high\u2010resolution manometry (HRM) and timed barium esophagram (TBE) in selection of patients for retreatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective observational cohort study was performed between November 2019 and October 2025 and included treated achalasia patients with recurrent or persistent symptoms who underwent FLIP in addition to HRM and TBE prior to retreatment. The primary outcome was the association between the distensibility index measured by FLIP and response to retreatment (treatment success: Eckardt score \u2264\u20093).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total 84 patients were included (median age 50\u2009years, 36.9% female). At a median follow\u2010up of 11\u2009weeks after retreatment, 82.1% had treatment success (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200969\/84) and 17.9% had treatment failure (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200915\/84). The distensibility index at 40\u2009mL on FLIP did not significantly differ between patients with and without treatment success (1.4\u2009mm\n                      <jats:sup>2<\/jats:sup>\n                      \/mmHg vs. 1.0\u2009mm\n                      <jats:sup>2<\/jats:sup>\n                      \/mmHg,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.463). Almost all patients with abnormal HRM and TBE results had treatment success (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200922\/23, 95.7%). In cases with inconclusive HRM and TBE results, treatment success was 83.3% when FLIP results were normal (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200910\/12) and 74.3% when FLIP results were abnormal (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200926\/35).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>FLIP did not provide added value over HRM and TBE for identifying treated achalasia patients who may benefit from further treatment. The difficulty in selecting achalasia patients for retreatment highlights the complexity of this patient population and underscores the need for further research.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nmo.70281","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T09:04:37Z","timestamp":1773133477000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Role of Functional Lumen Imaging Probe (\n                    <scp>FLIP<\/scp>\n                    ) in Addition to High\u2010Resolution Manometry and Timed Barium Esophagram in Treated Achalasia Patients With Persistent or Recurrent Symptoms"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3721-8279","authenticated-orcid":false,"given":"Elise M.","family":"Wessels","sequence":"first","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology Amsterdam Gastroenterology and Metabolism, University Medical Centers Amsterdam  Amsterdam the Netherlands"},{"name":"Amsterdam Gastroenterology, Endocrinology &amp; Metabolism  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niek","family":"Warringa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology Amsterdam Gastroenterology and Metabolism, University Medical Centers Amsterdam  Amsterdam the Netherlands"},{"name":"Amsterdam Gastroenterology, Endocrinology &amp; Metabolism  Amsterdam the Netherlands"},{"name":"Department of Gastroenterology &amp; Hepatology Isala Hospital  Zwolle the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2839-027X","authenticated-orcid":false,"given":"Gwen M. C.","family":"Masclee","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology Amsterdam Gastroenterology and Metabolism, University Medical Centers Amsterdam  Amsterdam the Netherlands"},{"name":"Amsterdam Gastroenterology, Endocrinology &amp; Metabolism  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeroen M.","family":"Schuitenmaker","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology Amsterdam Gastroenterology and Metabolism, University Medical Centers Amsterdam  Amsterdam the Netherlands"},{"name":"Amsterdam Gastroenterology, Endocrinology &amp; Metabolism  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert J.","family":"Bredenoord","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology Amsterdam Gastroenterology and Metabolism, University Medical Centers Amsterdam  Amsterdam the Netherlands"},{"name":"Amsterdam Gastroenterology, Endocrinology &amp; 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