Endoscopic ultrasound for the evaluation of Nissen fundoplication integrity: a blinded comparison with conventional testing.
Endoscopic ultrasound for the evaluation of Nissen fundoplication integrity: a blinded comparison with conventional testing.
复制标题
用于评估尼森胃底折叠术完整性的超声内镜：与传统测试的盲法比较。
DOI：
10.1007/s00464-007-9234-8
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
Jobe,BA
中科院分区：
文献类型：
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作者：
Chang,EY;Minjarez,RC;Kim,CY;Seltman,AK;Gopal,DV;Diggs,B;Davila,R;Hunter,JG;Jobe,BA
背景对于Nissen胃底折叠术后出现症状的患者，解剖失败的确切机制可能难以确定。作者之前报告了定义猪完整Nissen胃底折叠术的内镜超声特征和已知的失败原因。目前的临床试验测试的假设，一组定义的超声内镜标准可以应用于确定fundoplications的完整性在human.MethodsThe研究招募了7个有症状的和9个无症状的受试者平均为6年（范围，1-30年）后尼森fundoplications。完成经验证的胃食管反流病（GERD）特异性问卷和用药史。所有患者在内镜超声检查（EUS）前均接受完整的常规检查（上消化道内镜检查、食管造影、测压、24小时pH）。根据综合检查结果作出诊断。然后由一名对症状、药物使用和常规检查诊断不知情的观察者进行EUS。由于EUS和食管胃内窥镜检查（EGD）是统一联合进行的，因此EUS诊断是根据先前建立的标准结合EGD解释进行的。诊断，然后进行比较，检查EUS在此setting.ResultsThe技术和定义的标准很容易适用于所有科目的贡献。所有有症状的患者都有胃灼热，并服用质子泵抑制剂（PPI）。无无症状患者正在使用PPI。所有经常规检查确定的诊断均在EUS上结合上消化道内窥镜检查中检出。此外，EUS解决了2例有症状患者的下食管括约肌压力低的病因，并检测到2例受试者的其他滑脱诊断。在无症状的受试者中，EUS确定了额外的诊断，在两个主题被认为是正常的常规testing methods. ConclusionAccordingly的研究结果，EUS是一种可行的方法，用于评估后Nissen胃底折叠裂孔解剖关系。EUS和EGD的组合允许在Nissen胃底折叠术后出现术后症状的患者中检测失败的机制。
BackgroundFor patients whose symptoms develop after Nissen fundoplication, the precise mechanism of anatomic failure can be difficult to determine. The authors have previously reported the endosonographic hallmarks defining an intact Nissen fundoplication in swine and the known causes of failure. The current clinical trial tested the hypothesis that a defined set of endosonographic criteria can be applied to determine fundoplication integrity in humans.MethodsThe study enrolled seven symptomatic and nine asymptomatic subjects at a mean of 6 years (range, 1–30 years) after Nissen fundoplication. A validated gastroesophageal reflux disease (GERD)-specific questionnaire and medication history were completed. Before endoscopic ultrasound (EUS), all the patients underwent complete conventional testing (upper endoscopy, esophagram, manometry, 24-h pH). A diagnosis was rendered on the basis of combined test results. Then EUS was performed by an observer blinded to symptoms, medication use, and conventional testing diagnoses. Because EUS and esophagogastroduodenoscopy (EGD) are uniformly performed in combination, the EUS diagnosis was rendered on the basis of previously established criteria combined with the EGD interpretation. The diagnoses then were compared to examine the contribution of EUS in this setting.ResultsThe technique and defined criteria were easily applied to all subjects. All symptomatic patients had heartburn and were taking proton pump inhibitors (PPI). No asymptomatic patients were taking PPI. All diagnoses established with combined conventional testing were detected on EUS with upper endoscopy. Additionally, EUS resolved the etiology of a low lower esophageal sphincter pressure in two symptomatic patients and detected the additional diagnoses of slippage in two subjects. Among asymptomatic subjects, EUS identified additional diagnoses in two subjects considered to be normal by conventional testing methods.ConclusionAccording to the findings, EUS is a feasible method for evaluating post-Nissen fundoplication hiatal anatomic relationships. The combination of EUS and EGD allows the mechanism of failure to be detected in patients presenting with postoperative symptoms after Nissen fundoplication.