Intraoperative assessment of esophagogastric junction distensibility during per oral endoscopic myotomy (POEM) for esophageal motility disorders
Intraoperative assessment of esophagogastric junction distensibility during per oral endoscopic myotomy (POEM) for esophageal motility disorders
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DOI：
10.1007/s00464-012-2484-0
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发表时间：
2013-02-01
影响因子：
3.1
通讯作者：
Dunst, Christy M.
中科院分区：
文献类型：
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作者：
Rieder, Erwin;Swanstrom, Lee L.;Dunst, Christy M.
经口内镜肌切开术（POEM）是一种治疗食管动力障碍如贲门失弛缓症的新方法。迄今为止，肌切开术的范围是根据内窥镜医师的主观评估确定的。我们假设使用一种新型的功能性管腔成像探头实时测量食管胃交界处（EGJ）的扩张性，将能够客观评价POEM。诊断为贲门失弛缓症的患者选择性接受POEM。使用经口插入功能性管腔成像探头（EndoFLIP（A（R）的阻抗平面测量法，在经口肌切开术（n = 4）之前和之后立即测量EGJ的横截面积（CSA）和扩张。所有患者均完成了6个月的随访，2例患者此时重复进行了扩张性试验。4例正常志愿者作为对照组，POEM检查全部成功（4/4）。肌切开术前测量（40 ml填充模式）显示EGJ最西端位置的中位直径为6.5 mm（范围= 5.2-7.9 mm），POEM后为10.1 mm（7.3-13.2 mm）。CSA从41.5 mm（2）（20-49 mm（2））增加至86 mm（2）（41-137 mm（2）），球囊内压力中位数相似（40.3与38.6 mmHg）。EGJ扩张性增加（DI，1.0 vs. 2.4 mm（2）/mmHg）与健康志愿者（2.7 mm（2）/mmHg）相当。功能性管腔扩张性测量显示POEM可导致非松弛的食管下括约肌立即纠正，这与健康对照组相似。术中EGJ分析可能是一个重要的工具，以客观地指导所需的程度和完整性的肌切开术在POEM。
Per oral endoscopic myotomy (POEM) is a novel treatment for esophageal motility disorders such as achalasia. To date, the extent of the myotomy has been determined based on the subjective assessment of the endoscopist. We hypothesized that the real-time measurement of esophagogastric junction (EGJ) distensibility using a novel functional lumen-imaging probe would enable objective evaluation of POEM.Patients diagnosed with achalasia disorders electively underwent POEM. Using impedance planimetry with a transorally inserted functional lumen-imaging probe (EndoFLIP(A (R))), cross-sectional areas (CSA) and distensibilities at the EGJ were measured intraoperatively immediately before and after the transoral myotomy (n = 4). All patients completed their 6-month follow-up and two patients had repeat distensibility tests at this time. Four healthy volunteers served as a control group.POEM was successfully performed in all patients (4/4). Premyotomy measurements (40-ml fill mode) showed a median diameter of 6.5 mm (range = 5.2-7.9 mm) at the narrowest location of the EGJ and was 10.1 mm (7.3-13.2 mm) following POEM. CSA increased from 41.5 mm(2) (20-49 mm(2)) to 86 mm(2) (41-137 mm(2)) at a similar median intraballoon pressure (40.3 vs. 38.6 mmHg). The increased EGJ distensibility (DI, 1.0 vs. 2.4 mm(2)/mmHg) was comparable to that of healthy volunteers (2.7 mm(2)/mmHg).Functional lumen distensibility measures show that POEM can result in an immediate correction of the nonrelaxing lower esophageal sphincter, which appears similar to that of healthy controls. Intraoperative EGJ profiling may be an important tool to objectively guide the needed extent and completeness of the myotomy during POEM.