The Utility of Functional Luminal Imaging Probes Measurements to Diagnose Dysmotility and Their Relationship to Impaired Bolus Clearance.
The Utility of Functional Luminal Imaging Probes Measurements to Diagnose Dysmotility and Their Relationship to Impaired Bolus Clearance.
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DOI：
10.1097/mpg.0000000000003394
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发表时间：
2022-04-01
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;Stayn, Zachary;Garza, Jose M.;DiFilippo, Courtney;Cohen, Alexandra;Kane, Madeline;Wall, Stephanie;Nurko, Samuel
关键词：
功能性管腔成像探头（FLIP）已被多个中心用于评估食管梗阻风险患者的食管胃连接部（EGJ）功能，但其在诊断蠕动障碍方面的作用研究较少。特别是，没有研究比较FLIP通过高分辨率食管测压与阻抗诊断运动异常和药物传输受损的灵敏度。我们前瞻性招募了42名接受高分辨率食管测压和阻抗（HRIM）的患者，这些患者在2018年至2020年期间也接受了FLIP。使用Swallow Gateway软件分析HRIM参数，以确定蠕动和下食管括约肌压力测量值以及推注流量参数。分析FLIP描记是否存在重复性顺行收缩（RAC）、EGJ扩张性和相关参数。纳入42例患者（11例对照，7例贲门失弛缓症，16例胃底折叠术，8例运动障碍）。患者平均年龄为10.1±0.9岁。与胃底折叠术和动力障碍患者相比，对照组患者的推注存在时间较长（BPT）的诊断中的推注流量参数存在显著差异。EGJ直径、EGJ扩张性与固体食物的团注时间（BFT）呈显著相关（r 2> 0.518，P < 0.02）。RACs的存在和RACs期间EGJ松弛与跨纹理的更大BFT和BPT相关（P < 0.05）。然而，42%的RAC缺失患者的HRIM显示有明显的钙化。RAC的存在和通过FLIP的EGJ松弛与改善的团注流量相关。没有RAC的患者需要HRIM来确认任何运动障碍的诊断。
Functional luminal imaging probes (FLIP) have been used by multiple centers to assess esophagogastric junction (EGJ) function in patients at risk for esophageal obstruction but its role in diagnosing peristaltic disorders is less well studied. In particular, there are no studies comparing the sensitivity of FLIP to diagnose motility abnormalities and impaired bolus transit by high-resolution esophageal manometry with impedance. We prospectively recruited 42 patients undergoing high-resolution esophageal manometry with impedance (HRIM) who also underwent FLIP between 2018 and 2020. HRIM parameters were analyzed using Swallow Gateway software to determine peristaltic and lower esophageal sphincter pressure measurements as well as bolus flow parameters. FLIP tracings were analyzed for the presence of repetitive antegrade contractions (RACs), EGJ distensibility, and associated parameters. Forty-two patients were included (11 controls, 7 achalasia, 16 fundoplication, 8 dysmotility). The mean age of patients was 10.1±0.9 years. There were significant differences in bolus flow parameters across diagnosis with longer bolus presence (BPT) in control patients compared with fundoplication and dysmotility patients. There was a significant correlation between EGJ diameter, EGJ distensibility and bolus flow time (BFT) for solid foods (r2 > 0.518, P < 0.02). The presence of RACs and EGJ relaxation during RACs was associated with a greater BFT and BPT across textures (P < 0.05). Forty-two percentage of patients with absent RACs, however, had clear peristalsis by HRIM. The presence of RACs and EGJ relaxation by FLIP correlate with improved bolus flow. Patients with an absence of RACs need HRIM to confirm any diagnoses of dysmotility.