Diagnosis of Type-I hiatal hernia: a comparison of high-resolution manometry and endoscopy
Diagnosis of Type-I hiatal hernia: a comparison of high-resolution manometry and endoscopy
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DOI：
10.1111/j.1442-2050.2011.01314.x
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发表时间：
2013-01-01
影响因子：
2.6
通讯作者：
Dunst, C. M.
中科院分区：
文献类型：
--
作者：
Khajanchee, Y. S.;Cassera, M. A.;Dunst, C. M.
滑动型i型裂孔疝通常通过上内镜、钡餐或较少使用的食管测压来诊断。目前的资料显示，内窥镜检查优于钡餐或食管测压。最近，高分辨率测压法已可用于评估食管运动。该技术能够实时显示胃食管交界和脚膈的空间和地形压力分布图。本研究的目的是比较高分辨率测压法和内窥镜诊断胃食管反流病患者滑动裂孔疝的特异性和敏感性。回顾性分析了2006年1月至2009年1月期间考虑行腹腔镜抗反流手术的83例客观胃食管反流病患者（61%为女性，平均年龄52±13.2岁）的资料，并进行了术前高分辨率测压和内窥镜检查。从压力测量的角度来看，裂孔疝被定义为胃食管交界处从脚膈分离2.0 cm。术中诊断裂孔疝为金标准。采用阳性检测和阴性检测的敏感性、特异性和似然比来比较两种诊断方式的表现。42例患者在手术中发现i型滑脱裂孔疝（bbb2cm）。22例患者通过高分辨率测压达到裂孔疝的测压标准，36例患者通过术前内窥镜诊断为裂孔疝。与内窥镜检查相比，高分辨率测压术的假阳性结果明显减少（特异性更高）（4.88%比31.71%，P= 0.01）。两种诊断方式的假阴性结果（敏感性）差异无统计学意义（47.62% vs. 45.24%， P= 0.62）。阳性和阴性试验的似然比分析表明，高分辨率测压法在排除和排除裂孔疝方面都优于内窥镜检查。两个试验之间也存在显著差异（P= 0.033）。高分辨率测压法在胃食管反流患者中具有更好的特异性和排除明显的i型滑动裂孔疝的能力（阳性检测的可能性比更大）。由于假阴性结果较高，高分辨率测压和内窥镜检查对于裂孔疝的诊断都不可靠。两种方法均阴性的裂孔疝需要额外的检查。
Sliding Type-I hiatal hernia is commonly diagnosed using upper endoscopy, barium swallow or less commonly, esophageal manometry. Current data suggest that endoscopy is superior to barium swallow or esophageal manometry. Recently, high-resolution manometry has become available for the assessment of esophageal motility. This novel technology is capable of displaying spatial and topographic pressure profiles of gastroesophageal junction and crural diaphragm in real time. The objective of the current study was to compare the specificity and sensitivity of high-resolution manometry and endoscopy in the diagnosis of sliding hiatal hernia in patients with gastroesophageal reflux disease. Data were analyzed retrospectively for 83 consecutive patients (61% females, mean age 52 +/- 13.2 years) with objective gastroesophageal reflux disease who were considered for laparoscopic antireflux surgery between January 2006 and January 2009 and had preoperative high-resolution manometry and endoscopy. Manometrically, hiatal hernia was defined as separation of the gastroesophageal junction >2.0 cm from the crural diaphragm. Intraoperative diagnosis of hiatal hernia was used as the gold standard. Sensitivity, specificity and likelihood ratios of a positive test and a negative test were used to compare the performance of the two diagnostic modalities. Forty-two patients were found to have a Type-I sliding hiatal hernia (>2 cm) during surgery. Twenty-two patients had manometric criteria for a hiatal hernia by high-resolution manometry, and 36 patients were described as having a hiatal hernia by preoperative endoscopy. False positive results were significantly fewer (higher specificity) with high-resolution manometry as compared with endoscopy (4.88% vs. 31.71%, P= 0.01). There were no significant differences in the false negative results (sensitivity) between the two diagnostic modalities (47.62% vs. 45.24%, P= 0.62). Analysis of likelihood ratios of a positive and negative test demonstrated that high-resolution manometry is better than endoscopy both to rule out and rule in a hiatal hernia. A significant discordance was also observed between the two tests (P= 0.033). High-resolution manometry has better specificity and ability to rule out an overt Type-I sliding hiatal hernia (greater likelihood ratio of a positive test) in patients with GERD. Because of high false negative results, both high-resolution manometry and endoscopy are unreliable for ruling in a hiatal hernia. Negative result for a hiatal hernia by either modality mandates additional testing.