Clinical significance of esophagogastroduodenoscopy in patients with esophageal motility disorders
Clinical significance of esophagogastroduodenoscopy in patients with esophageal motility disorders
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DOI：
10.1111/den.13836
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发表时间：
2020-10-13
影响因子：
5.3
通讯作者：
Haruma, Ken
中科院分区：
文献类型：
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作者：
Matsubara, Masaki;Manabe, Noriaki;Haruma, Ken
目的本研究的第一个目的是阐明食管胃镜检查（EGD）在吞咽困难伴食管动力障碍患者中的检出率;第二个目的是阐明EGD与食管动力障碍相关的有用参数。方法研究对象包括380例在高分辨率测压（HRM）治疗吞咽困难之前接受EGD的患者。根据以下五个参数研究EGD结果：通过食管胃交界处（EGJ）时的阻力、食管腔内的残留物、食管扩张以及痉挛性和非闭塞性收缩。HRM诊断基于芝加哥分类（v3.0）。结果食管动力障碍患者EGD异常率为64.4%，不同食管动力障碍EGD异常率不同。EGJ流出道梗阻和主要疾病的EGD异常率均显著高于测压正常受试者。多变量分析显示，通过EGJ时的阻力、食管腔内残留物、痉挛性和非闭塞性收缩与食管动力障碍显著相关。这些参数检测食管动力障碍的敏感性、特异性、阳性预测值和阴性预测值分别为75.1%、86.6%、84.8%和77.8%。结论EGD可用于食管胃连接部流出道梗阻及胃肠道主要疾病的筛查。在几个内镜参数中，通过EGJ时的阻力、食管腔内残留物、痉挛性和非闭塞性收缩被认为是非常有用的指标。
Objectives The first aim of this study was to elucidate the detection rate of esophagogastroduodenoscopy (EGD) in patients complaining of dysphagia with esophageal motility disorders; the second was to clarify the useful parameters of EGD associated with esophageal motility disorders. Methods Participants included 380 patients who underwent EGD before high-resolution manometry (HRM) for dysphagia. EGD findings were investigated according to the following five parameters: resistance when passing through the esophagogastric junction (EGJ), residue in the esophageal lumen, esophageal dilation, and spastic and nonocclusive contractions. HRM diagnoses were based on the Chicago classification (v3.0). Results The percentage of abnormal EGD findings was 64.4% among patients with esophageal motility disorders, and the results differed for each esophageal motility disorder. The rate of abnormal EGD for both EGJ outflow obstruction and major disorders of peristalsis was significantly higher than that for manometrically normal subjects. On multivariate analysis, resistance when passing through EGJ, residue in the esophageal lumen, spastic and nonocclusive contraction were significantly associated with esophageal motility disorders. The sensitivity, specificity, positive predictive value, and negative predictive value of these parameters for detection of esophageal motility disorders were 75.1%, 86.6%, 84.8% and 77.8%, respectively. Conclusion Esophagogastric junction outflow obstruction and major disorders of peristalsis can be screened with EGD. Among several endoscopic parameters, resistance when passing through EGJ, residue in the esophageal lumen, spastic and nonocclusive contraction are considered significantly useful indicators.