Comparison of esophagogastric junction distensibility changes during POEM and Heller myotomy using intraoperative FLIP
Comparison of esophagogastric junction distensibility changes during POEM and Heller myotomy using intraoperative FLIP
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DOI：
10.1007/s00464-013-3121-2
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发表时间：
2013-12-01
影响因子：
3.1
通讯作者：
Hungness, Eric S.
中科院分区：
文献类型：
--
作者：
Teitelbaum, Ezra N.;Boris, Lubomyr;Hungness, Eric S.
经口内镜肌切开术（POEM）是一种治疗贲门失弛缓症的新型内镜外科手术。POEM和腹腔镜Heller肌切开术（LHM）对食管胃连接部（EGJ）生理学的比较效果尚不清楚。一种新的测量导管，功能性管腔成像探头（FLIP），允许术中评估EGJ的顺应性，通过测量管腔的几何形状和压力，在容量控制的expansions. Expensibility指数（DI）（定义为在EGJ的最小横截面积除以压力）进行LHM和POEM患者术中FLIP测量。在每个手术步骤后进行单独测量。在LHM期间，在以下各项之后进行测量：（1）麻醉诱导，（2）气腹，（3）食管裂孔剥离和食管松动术，（4）肌切开术，（5）部分胃底折叠术，以及（6）排气。在POEM中，他们在（1）麻醉诱导，（2）粘膜下隧道创建，（3）肌切开术后进行。11例LHM和14例POEM患者进行术中FLIP。两组之间的基线DI相似。LHM导致平均DI总体增加（使用40 ml扩张体积，术前1.4 vs术后7.6 mm（2）/mmHg; p < 0.001）。气腹的吹入和食管裂孔剥离不影响DI。肌切开术导致DI增加。部分胃底折叠术（Toupet 6例，Dor 5例）导致DI降低，脱气导致DI增加。POEM还导致平均DI总体增加（术前1.4 vs术后7.9 mm（2）/mmHg; p < 0.001）。单独测量，粘膜下隧道创建和肌切开术均引起DI增加。当比较总体变化时，LHM和POEM之间DI增加量没有差异。POEM和LHM导致术中EGJ扩张性的相似改善。需要进一步研究术中FLIP测量与术后症状和生理结局的相关性。
Peroral endoscopic myotomy (POEM) is a novel endoscopic surgical procedure for the treatment of achalasia. The comparative effects of POEM and laparoscopic Heller myotomy (LHM) on esophagogastric junction (EGJ) physiology are unknown. A novel measurement catheter, the functional lumen imaging probe (FLIP), allows for intraoperative evaluation of EGJ compliance by measuring luminal geometry and pressure during volume-controlled distensions.Distensibility index (DI) (defined as the minimum cross-sectional area at the EGJ divided by pressure) was measured with FLIP intraoperatively in patients undergoing LHM and POEM. Separate measurements were taken after each operative step. During LHM, measurements were performed after: (1) induction of anesthesia, (2) insufflation of pneumoperitoneum, (3) hiatal dissection and esophageal mobilization, (4) myotomy, (5) partial fundoplication, and (6) deinsufflation. During POEM, they were performed after: (1) induction of anesthesia, (2) submucosal tunnel creation, and (3) myotomy.Eleven LHM and 14 POEM patients underwent intraoperative FLIP. Baseline DI was similar between groups. LHM resulted in an overall increase in mean DI (pre 1.4 vs. post 7.6 mm(2)/mmHg, using a 40-ml distension volume; p < 0.001). Insufflation of pneumoperitoneum and hiatal dissection did not affect DI. Myotomy caused an increase in DI. Partial fundoplication (6 Toupet, 5 Dor) caused a decrease in DI, and deinsufflation caused an increase in DI. POEM also resulted in an overall increase in mean DI (pre 1.4 vs. post 7.9 mm(2)/mmHg; p < 0.001). Measured individually, both submucosal tunnel creation and myotomy caused increases in DI. When overall changes were compared, there were no differences in the amount of DI increase between LHM and POEM.POEM and LHM result in a similar improvement in EGJ distensibility intraoperatively. Further study is needed to correlate intraoperative FLIP measurements with postoperative symptomatic and physiologic outcomes.