Identifying spastic variant of type II achalasia after treatment with high-resolution manometry and FLIP Panometry.
Identifying spastic variant of type II achalasia after treatment with high-resolution manometry and FLIP Panometry.
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使用高分辨率测压法和 FLIP Panometry 治疗后识别 II 型贲门失弛缓症的痉挛变异。
DOI：
10.1111/nmo.14552
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发表时间：
2023
影响因子：
3.5
通讯作者：
Carlson,DustinA
中科院分区：
文献类型：
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作者：
Vespa,Edoardo;Farina,DomenicoA;Kahrilas,PeterJ;Kou,Wenjun;Low,EricE;Yadlapati,Rena;Pandolfino,JohnE;Carlson,DustinA
背景全食管加压（PEP）在高分辨率测压（HRM）上定义为II型贲门失弛缓症，但一些患者在治疗后出现痉挛。芝加哥分类（CC）v4.0提出高PEP值嵌入痉挛的预测，但支持性证据是lacked.MethodsFifty 7型贲门失弛缓症患者（47 ± 18岁，54%男性）与HRM和LIP Panometry治疗前后进行了回顾性研究。对基线HRM和FLIP研究进行分析，以确定与治疗后痉挛相关的因素，根据CC v4.0定义HRM。结果7例患者（12%）在治疗后发生痉挛（经口内镜下肌切开术47%;气动扩张[PD] 37%;腹腔镜Heller肌切开术16%）。基线时，HRM上更大的中位最大PEP压力（MaxPEP）值（77 vs 55 mmHg，p= 0.045）和FLIP上的痉挛反应性收缩反应模式（43% vs 8%，p = 0.033）在治疗后痉挛患者中更常见，而FLIP上无收缩反应在无痉挛患者中更常见（14% vs 66%，p = 0.014）。治疗后痉挛的最强预测因子是MaxPEP ≥70 mmHg的吞咽百分比（最佳临界值：≥30%），AUROC为0.78。MaxPEP <70 mmHg和FLIP 60 mL压力< 40 mmHg的组合确定了治疗后痉挛发生率较低的患者（总体3%，PD后0%）与数值高于这些阈值的患者相比（总体为33%，PD后为83%）。治疗前较高的FLIP 60 mL压力和FLIP Panometry上的收缩反应模式识别出II型贲门失弛缓症患者更可能表现出治疗后痉挛。评估这些特征可以指导个性化的患者管理。
BackgroundPanesophageal pressurization (PEP) defines type II achalasia on high‐resolution‐manometry (HRM) but some patients exhibit spasm after treatment. The Chicago Classification (CC) v4.0 proposed high PEP values as predictor of embedded spasm, yet supportive evidence is lacking.MethodsFifty seven type II achalasia patients (47 ± 18 years, 54% males) with HRM and LIP Panometry before and after treatment were retrospectively identified. Baseline HRM and FLIP studies were analyzed to identify factors associated with post‐treatment spasm, defined on HRM per CC v4.0.ResultsSeven patients (12%) had spasm following treatment (peroral endoscopic myotomy 47%; pneumatic dilation [PD] 37%; laparoscopic Heller myotomy 16%). At baseline, greater median maximum PEP pressure (MaxPEP) values on HRM (77 vs 55 mmHg,p= 0.045) and spastic‐reactive contractile response pattern on FLIP (43% vs 8%,p= 0.033) were more common in patients with post‐treatment spasm while absent contractile response on FLIP was more common in patients without spasm (14% vs 66%,p= 0.014). The strongest predictor of post‐treatment spasm was the percentage of swallows with MaxPEP ≥70 mmHg (best cut‐off: ≥30%), with AUROC of 0.78. A combination of MaxPEP <70 mmHg and FLIP 60 mL pressure < 40 mmHg identified patients with lower rates of post‐treatment spasm (3% overall, 0% post‐PD) compared to those with values above these thresholds (33% overall, 83% post‐PD).ConclusionsHigh maximum PEP values, high FLIP 60 mL pressures and contractile response pattern on FLIP Panometry prior to treatment identified type II achalasia patients more likely to exhibit post‐treatment spasm. Evaluating these features may guide personalized patient management.