Functional Luminal Imaging Probe Assessment in Postfundoplication Patients Changes Management Beyond Manometry.
Functional Luminal Imaging Probe Assessment in Postfundoplication Patients Changes Management Beyond Manometry.
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DOI：
10.1097/mpg.0000000000002658
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发表时间：
2020-06
影响因子：
2.9
通讯作者：
Nurko, Samuel
中科院分区：
文献类型：
--
作者：
Rosen, Rachel;Garza, Jose M.;Nurko, Samuel
关键词：
胃底折叠术是一种常见的儿科手术，但手术可能导致非特异性症状，值得进一步评估。本研究的目的是确定功能性管腔成像探头（FLIP）与高分辨率阻抗测压（HRIM）在评价胃底折叠症状中的效用。我们回顾了有症状的胃底折叠术患者的FLIP和HRIM描记。我们比较了胃底折叠术患者的FLIP结果与儿童贲门失弛缓症和对照组患者的FLIP结果。我们还比较了FLIP和HRIM在临床决策和临床结局中的作用。胃底折叠术患者的EGJ扩张范围为0.6至8.2 mm 2/mm Hg。由于儿科患者体型不同（8.9 - 73.5 kg），球囊尺寸充盈不同，但在根据体重调整球囊充盈体积后，充盈和扩张性之间存在线性关系。与对照组和贲门失弛缓症患者相比，胃底折叠术患者的扩张度低于对照组，高于贲门失弛缓症患者（p=0.0001）。接受EGJ干预的患者的平均EGJ扩张性为2.3±1.1 mm 2/mm Hg，而药物治疗患者为5.1±1.6 mm 2/mm Hg（p=0.0001）。接受EGJ干预的患者的平均IRP为13.9 ± 6.1 mm Hg，而药物治疗患者的平均IRP为9.9±3.9 mm Hg（p=0.3）。总之，我们表明FLIP可以提供更多的了解EGJ生理症状胃底折叠术患者和补充HRIM。
Fundoplication is a commonly performed pediatric surgery but the surgery can result in nonspecific symptoms that merit further evaluation. The goal of this study was to determine the utility of Functional Luminal Imaging Probe (FLIP) compared to high resolution manometry with impedance (HRIM) in the evaluation of fundoplication symptoms. We reviewed the FLIP and HRIM tracings of symptomatic fundoplication patients. We compared FLIP results of fundoplication patients to those of pediatric achalasia and control patients. We also compared the role of FLIP to HRIM in clinical decision making and clinical outcomes. EGJ distensibilities of fundoplication patients ranged from 0.6 to 8.2 mm2/mm Hg. Because of the different pediatric patient sizes (8.9 to 73.5 kg), balloon size inflations varied but, after adjusting balloon fill volume by weight, there was a linear relationship between inflation and distensibility. When compared to control patients and achalasia patients, distensibilities of fundoplication patients were lower than control patients and higher than achalasia patients (p=0.0001). Patients who had an EGJ intervention had a mean EGJ distensibility of 2.3±1.1 mm2/mm Hg compared to 5.1±1.6 in mm2/mm Hg in medically managed patients (p=0.0001). Patients who had an EGJ intervention had a mean IRP of 13.9 ± 6.1 mm Hg compared to medically managed patients who had a mean IRP of 9.9±3.9 mm Hg (p=0.3). In conclusion, we show FLIP may provide additional insight into EGJ physiology in symptomatic fundoplication patients and complements HRIM.