The emerging role of endoscopy in neurogastroenterology.

PURPOSE OF REVIEW: Purpose of the review is provision of an up-to-date literature review on the growing importance of endoscopy in neurogastroenterology and its limitations. RECENT FINDINGS: Traditionally, the diagnostic role of endoscopy in neurogastroenterology lies in the initial suspicion of motility disorders and exclusion of important differential diagnoses. Endoscopy may serve also as a carrier for positioning examination devices such as the Bravo reflux-capsule to proof gastroesophageal reflux or the endoluminal functional lumen imaging probe (EndoFLIP). New interesting aspects are the resection-based and biopsy-based extraction of tissue for examination of the enteric nervous system by the full thickness resection device (FTRD) to detect structural gastrointestinal neuromuscular lesion and confocal laser endomicroscopy (CLE) to investigate potential correlations for food intolerance. Effectiveness of endoscopic therapy is dependent on whether the measured circumscribed dysfunction correlates with the symptoms and explains them. This is the case in esophageal achalasia and hypercontractile motility disorders. However, in gastropareses, the significance of endoscopic therapy is limited because of its complex pathophysiology. SUMMARY: There is an emerging role of endoscopy in neurogastroenetrology. However, effectiveness of endoscopic therapy is dependent on careful patient selection and evidence of a circumscribed dysfunction that correlates with the symptoms and explains them.