Optimal cutoff value of integrated relaxation pressure on the esophagogastric junction to detect outflow obstruction using starlet high-resolution manometry system
Optimal cutoff value of integrated relaxation pressure on the esophagogastric junction to detect outflow obstruction using starlet high-resolution manometry system
复制标题
应用Starlet高分辨率测压系统检测食管胃交界处综合舒张压检测流出道梗阻的最佳截止值
DOI：
10.1007/s00535-020-01757-w
复制
发表时间：
2021-01-09
影响因子：
6.3
通讯作者：
Kashiwagi, Hideyuki
中科院分区：
文献类型：
--
作者：
Masuda, Takahiro;Yano, Fumiaki;Kashiwagi, Hideyuki
背景贲门失弛缓症和食管胃连接部流出道梗阻（EGJOO）是以食管下括约肌（LES）吞咽松弛受损为特征的特发性食管动力障碍。高分辨率测压（HRM）提供了综合舒张压（IRP），其代表LES舒张的充分性。Starlet HRM系统在日本广泛使用;然而，尚未对使用Starlet系统评估的贲门失弛缓症/EGJOO患者的IRP值进行充分研究。我们提出了使用Starlet系统检测贲门失弛缓症/EGJOO的最佳IRP截止值。方法纳入2018年7月至2020年9月在我院使用Starlet系统进行HRM测试的患者。其中，我们纳入了贲门失弛缓症或EGJOO患者以及食管动力正常但无食管裂孔疝的患者。异常受损的LES松弛（即，结果111例患者均符合研究标准，其中贲门失弛缓症（贲门失弛缓症）和EGJOO（食管贲门失弛缓症和EGJOO）患者均符合研究标准。其中，48例患者被诊断为贲门失弛缓症（n = 45 [I型，n = 20; II型，n = 22; III型，n = 3]）或EGJOO（n = 3）。在基于TBE的食管清除率延长的48例患者中，IRP值分布在最小值14.1至最大值72.2 mmHg的广泛范围内，范围沿着扩大。IRP的最佳临界值为24.7 mmHg，敏感性为89.6%，特异性为84.1%（AUC0.94）。结论在本队列中，使用Starlet HRM系统，IRP区分失弛缓症/EGJOO的最佳临界值为>= 25 mmHg。这表明当前拟定的临界值26 mmHg似乎具有相关性。
Background Achalasia and esophagogastric junction outflow obstruction (EGJOO) are idiopathic esophageal motility disorders characterized by impaired deglutitive relaxation of the lower esophageal sphincter (LES). High-resolution manometry (HRM) provides integrated relaxation pressure (IRP) which represents adequacy of LES relaxation. The Starlet HRM system is widely used in Japan; however, IRP values in achalasia/EGJOO patients assessed with the Starlet system have not been well studied. We propose the optimal cutoff of IRP for detecting achalasia/EGJOO using the Starlet system.Methods Patients undergone HRM test using the Starlet system at our institution between July 2018 and September 2020 were included. Of these, we included patients with either achalasia or EGJOO and those who had normal esophageal motility without hiatal hernia. Abnormally impaired LES relaxation (i.e., achalasia and EGJOO) was diagnosed if prolonged esophageal emptying was evident based on timed barium esophagogram (TBE).Results A total of 111 patients met study criteria. Of these, 48 patients were diagnosed with achalasia (n = 45 [type I, n = 20; type II, n = 22; type III, n = 3]) or EGJOO (n = 3). In the 48 patients who had a prolonged esophageal clearance based on TBE, IRP values distributed along a wide-range of minimal 14.1 to a maximal of 72.2 mmHg. The optimal cutoff value of IRP was 24.7 mmHg with sensitivity of 89.6% and specificity of 84.1% (AUC 0.94).Conclusion The optimal cutoff value of IRP to distinguish achalasia/EGJOO was >= 25 mmHg using the Starlet HRM system in our cohort. This indicates that the current proposed cutoff of 26 mmHg appears to be relevant.