Does Measurement of Esophagogastric Junction Distensibility by EndoFLIP Predict Therapy- responsiveness to Endoluminal Fundoplication in Patients With Gastroesophageal Reflux Disease?
Does Measurement of Esophagogastric Junction Distensibility by EndoFLIP Predict Therapy- responsiveness to Endoluminal Fundoplication in Patients With Gastroesophageal Reflux Disease?
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DOI：
10.5056/jnm14111
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发表时间：
2015-03-30
影响因子：
3.4
通讯作者：
Conchillo JM
中科院分区：
文献类型：
--
作者：
Smeets FG;Keszthelyi D;Bouvy ND;Masclee AA;Conchillo JM
在胃食道反流病(GERD)患者中，已经描述了食管胃交界处(EGJ)扩张性增加。使用内窥镜功能腔成像探头(EndoFLIP)技术评估EGJ的扩张性可以确定患者对经口腔无切口胃底折叠术(TIF)的反应，而术后EGJ的扩张性的测量可能有助于深入了解TIF的抗反流机制。因此，我们研究了EndoFLIP技术在接受TIF治疗的GERD患者中的价值。42例GERD患者在TIF前使用EndoFLIP技术进行EGJ扩张性测量。在25名患者的亚组中，在术后和6个月的随访中重复进行EndoFLIP测量。根据TIF术后6个月食管酸暴露时间(AET；客观结果)和症状评分(临床结果)评价治疗结果。多因素Logistic回归分析显示，术前EGJ扩张性(OR0.16；95%CI0.03~0.78；P=0.023)和AET(OR0.62；95%CI0.42~0.90；P=0.013)是TIF术后客观治疗结果的独立预测因素，而不是临床结果的独立预测因素。手术前EGJ扩张性的最佳分界值为2.3 mm~2/mm Hg，AET的分界值为11%。术后6个月的扩张性由术前的2.0(1.2~3.3)mm~2/mm Hg降至1.4(1.0~2.2)mm~2/mm Hg(P=0.014)，6个月后升至2.2(1.5~3.0)mm~2(P=0.925)。术前EGJ扩张性和术前AET是TIF术后客观治疗结果的独立预测因素，而不是临床结果的独立预测因素。根据我们的数据，无论是在术前诊断工作中，还是在腔内抗反流治疗的术后评估中，EndoFLIP技术都没有任何附加价值。
In patients with gastroesophageal reflux disease (GERD), an increased esophagogastric junction (EGJ) distensibility has been described. Assessment of EGJ distensibility with the endoscopic functional luminal imaging probe (EndoFLIP) technique might identify patients responsive to transoral incisionless fundoplication (TIF), whereas postoperative measurement of EGJ distensibility might provide insight into the antireflux mechanism of TIF. Therefore, we investigated the value of the EndoFLIP technique in GERD patients treated by TIF. Forty-two GERD patients underwent EGJ distensibility measurement before TIF using the EndoFLIP technique. In a subgroup of 25 patients, EndoFLIP measurement was repeated both postoperative and at 6 months follow-up. Treatment outcome was assessed according to esophageal acid exposure time (AET; objective outcome) and symptom scores (clinical outcome) 6 months after TIF. Multiple logistic regression analysis showed that preoperative EGJ distensibility (OR, 0.16; 95% CI, 0.03–0.78; P = 0.023) and preoperative AET (OR, 0.62; 95% CI, 0.42–0.90; P = 0.013) were independent predictors for objective treatment outcome but not for clinical outcome after TIF. The best cut-off value for objective outcome was 2.3 mm2/mmHg for preoperative EGJ distensibility and 11% for preoperative AET. EGJ distensibility decreased direct postoperative from 2.0 (1.2–3.3) to 1.4 (1.0–2.2) mm2/mmHg (P = 0.014), but increased to 2.2 (1.5–3.0) at 6 months follow-up (P = 0.925, compared to preoperative). Preoperative EGJ distensibility and preoperative AET were independent predictors for objective treatment outcome but not for clinical outcome after TIF. According to our data, the EndoFLIP technique has no added value either in the preoperative diagnostic work-up or in the post-procedure evaluation of endoluminal antireflux therapy.
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作者：
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