Assessment of esophageal body peristaltic work using functional lumen imaging probe panometry
Assessment of esophageal body peristaltic work using functional lumen imaging probe panometry
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DOI：
10.1152/ajpgi.00324.2020
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发表时间：
2021-02-01
影响因子：
4.5
通讯作者：
Patankar, Neelesh A.
中科院分区：
文献类型：
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作者：
Acharya, Shashank;Halder, Sourav;Patankar, Neelesh A.
本研究的目的是概念化和计算食道所做的“机械功”测量，使用功能性管腔成像探针（FLIP）测量产生的数据，并比较患者和对照组在继发性蠕动期间所做的功。在镇静内窥镜检查期间用16厘米FLIP对85人进行评估，包括无症状对照组（n = 14）和失弛缓症I、II和III亚型患者（各n = 15）；胃食管反流病（GERD, n = 13）；嗜酸性粒细胞性食管炎（EoE; n = 9）；系统性硬化症（SSc; n = 5）。在逐步扩张过程中，FLIP导管的远端段横跨食管胃交界处（EGJ）。评估了两项工作指标：“活跃工作”（当袋容量为60 mL时，收缩性不能实质性改变管腔面积）。对照组的活跃工作中位数[四分位数间距（IQR）]为7.3 (3.6-9.2)mJ，工作能力为268.6 (225.2-332.3)mJ。所有贲门失弛缓症亚型、GERD和SSc患者的活动量均低于对照组（P < 0.003）。贲门失弛缓症I和II亚型、GERD和SSc患者的工作能力较对照组低（P分别< 0.001、0.004、0.04和0.001）。工作能力在对照组和III型失弛缓症和EoE患者之间相似。食道机械功在健康对照组与贲门失弛缓症、EoE、SSc和GERD患者组之间存在差异。需要进一步的研究来充分探索这种方法的实用性，但这些功指标对于设备设计（人工食管），测量蠕动的有效性，测量食管的生理状态以及评价其泵送有效性有价值。功能管腔成像探针（FLIP）测量法评估食管对扩张的反应，并在收缩期间同时评估压力和尺寸。这使我们能够客观地评估食道所做的“机械功”。85个人被评估，并为每个受试者计算两个工作指标。与贲门失弛缓症、胃食管反流病（GERD）和系统性硬化症（SSc）患者相比，对照组显示出更大的工作价值。这些值可以量化远端食道的力学行为，并有助于估计肌肉的完整性。
The goal of this study was to conceptualize and compute measures of "mechanical work" done by the esophagus using data generated during functional lumen imaging probe (FLIP) panometry and compare work done during secondary peristalsis among patients and controls. Eighty-five individuals were evaluated with a 16-cm FLIP during sedated endoscopy, including asymptomatic controls (n = 14) and those with achalasia subtypes I, II, and III (n = 15, each); gastroesophageal reflux disease (GERD; n = 13); eosinophilic esophagitis (EoE; n = 9); and systemic sclerosis (SSc; n = 5). The FLIP catheter was positioned to have its distal segment straddling the esophagogastric junction (EGJ) during stepwise distension. Two metrics of work were assessed: "active work" (during bag volumes 60 mL when contractility cannot substantially alter the lumen area). Controls showed median [interquartile range (IQR)] of 7.3 (3.6-9.2) mJ of active work and 268.6 (225.2-332.3) mJ of work capacity. Patients with all achalasia subtypes, GERD, and SSc showed lower active work done than controls (P < 0.003). Patients with achalasia subtypes I and II, GERD, and SSc had lower work capacity compared with controls (P < 0.001, 0.004, 0.04, and 0.001, respectively). Work capacity was similar between controls and patients with achalasia type III and EoE. Mechanical work of the esophagus differs between healthy controls and patient groups with achalasia, EoE, SSc, and GERD. Further studies are needed to fully explore the utility of this approach, but these work metrics would be valuable for device design (artificial esophagus), to measure the efficacy of peristalsis, to gauge the physiological state of the esophagus, and to comment on its pumping effectiveness.NEW & NOTEWORTHY Functional lumen imaging probe (FLIP) panometry assesses esophageal response to distension and provides a simultaneous assessment of pressure and dimension during contractility. This enables an objective assessment of "me-chanical work" done by the esophagus. Eighty-five individuals were evaluated, and two work metrics were computed for each subject. Controls showed greater values of work compared with individuals with achalasia, gastroesophageal reflux disease (GERD), and systemic sclerosis (SSc). These values can quantify the mechanical behavior of the distal esophagus and assist in the estimation of muscular integrity.