This review by Thomas Frieling (Curr Opin Gastroenterol. 2026;42(5):306–311; PMID 42559899; DOI 10.1097/MOG.0000000000001188) provides an up-to-date literature summary on the expanding applications and limitations of endoscopy in neurogastroenterology. The article focuses on how endoscopic techniques contribute to diagnosis, device-assisted testing, tissue acquisition for enteric nervous system analysis, and endoscopic therapies, and it underscores the importance of correlating measured dysfunction with patient symptoms.
Traditionally, endoscopy in neurogastroenterology has supported the initial clinical suspicion of motility disorders and has played a key role in excluding important differential or structural diagnoses. Endoscopy remains a frontline tool to rule out mucosal disease or structural obstruction before further functional testing is pursued.
Endoscopic procedures increasingly serve as platforms to position and deploy diagnostic devices. The review highlights use of the Bravo reflux capsule to demonstrate gastroesophageal reflux and the endoluminal functional lumen imaging probe (EndoFLIP) to evaluate luminal distensibility and function. These device-assisted investigations extend the diagnostic capacity of endoscopy beyond visual mucosal assessment and enable physiologic measurements during endoscopic procedures.
The author reports that newer endoscopic resection and biopsy methods permit access to deeper layers for evaluation of the enteric nervous system. The full-thickness resection device (FTRD) is specifically mentioned as a tool to obtain resection-based and biopsy-based tissue samples to detect structural gastrointestinal neuromuscular lesions. Such samples can support investigation of structural causes of motility disorders that would not be evident from mucosal biopsies alone.
Confocal laser endomicroscopy (CLE) is described as a technique that can investigate mucosal and microstructural features in vivo and may help explore potential correlations with food intolerance. The review notes CLE as an emerging modality to examine local mucosal reactions that could relate to symptom generation or intolerance mechanisms, although the article does not provide detailed outcomes or diagnostic thresholds.
A central message in the review is that the effectiveness of endoscopic therapy depends on demonstrating a circumscribed, measurable dysfunction that plausibly explains the patient's symptoms. When physiologic testing or imaging identifies a localized functional abnormality, endoscopic or endoscopic-assisted therapy is more likely to achieve symptomatic benefit. The review cites esophageal conditions where this principle applies clearly.
By contrast, the review highlights that in disorders with complex, multifactorial pathophysiology such as gastroparesis, the value of endoscopic therapies is limited. Because gastroparesis often involves heterogeneous mechanisms and widespread neuromuscular dysfunction, targeting a single circumscribed abnormality endoscopically may not address the full basis of symptoms. The author therefore emphasizes cautious interpretation of endoscopic findings and restraint in selecting endoscopic therapies for gastroparesis unless a clear, localized target is established.
The review concludes that there is an emerging role for endoscopy in neurogastroenterology encompassing diagnostic exclusion, device-based physiologic testing (for example, Bravo and EndoFLIP), tissue sampling of deeper layers with FTRD, and mucosal microanalysis with CLE. Importantly, the clinical value of endoscopic therapeutic interventions hinges on careful patient selection and evidence that a circumscribed dysfunction correlates with and explains the presenting symptoms. Endoscopic approaches appear most promising when applied to disorders such as achalasia and hypercontractile esophageal motility disorders where a focal dysfunction is demonstrable, whereas their significance in conditions like gastroparesis is more limited.
The review emphasizes application-focused decision-making: use endoscopy and device-assisted methods to confirm or exclude structural and focal functional abnormalities, and reserve endoscopic therapies for patients in whom objective findings align with clinical symptoms. Details on specific procedural outcomes, comparative effectiveness, or quantitative thresholds were not reported in the abstract source.