Role of endoscopic functional luminal imaging probe in predicting the outcome of gastric peroral endoscopic pyloromyotomy (with video)
Role of endoscopic functional luminal imaging probe in predicting the outcome of gastric peroral endoscopic pyloromyotomy (with video)
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DOI：
10.1016/j.gie.2020.01.044
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发表时间：
2020-06-01
影响因子：
7.7
通讯作者：
Khashab, Mouen A.
中科院分区：
文献类型：
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作者：
Vosoughi, Kia;Ichkhanian, Yervant;Khashab, Mouen A.
背景和目的：腔内功能性管腔成像探头(EndoFLIP)是一种测量胃肠道括约肌生理特性的成像工具。在这项研究中，我们使用EndoFLIP评估难治性胃轻瘫患者幽门生理测量与胃镜下肌切开术(G-PEIP)的临床结果之间的关系。方法：对5个中心37名接受G-PENG治疗的难治性胃瘫患者进行评估。用EndoFLIP分别在G-PENG前、后分别用40mL和50mL球囊充填法测定幽门横截面积(CSA)、球囊压力和幽门扩张指数(DI)。结果：26例(70%)患者在接受G-POEM治疗后3个月的临床成功率和胃排空变化研究与EndoFLIP测量结果进行了比较。治疗成功组治疗后CsA和DI均显著高于治疗成功组(CsA：89.9±/-64.8vs 172.5±/-71.9 mm(2)，P=0.003；DI：5.8±/-4.4vs 8.8+/-6.1 mm(2)/mm Hg，P=0.043)；DI：5.6+/-3.3vs 9.9+/-6.6 mm(2)/mm Hg，P=0.049)。曲线下面积为0.83的40mLCSA，以154 mm(2)为临界点，其特异度为91%，敏感度为71%。结论：G-PEOTE后幽门CSA检查与临床疗效和胃排空检查的改善密切相关。幽门的EndoFLIP测量有可能被用作预测G-PENG临床结果的工具。
Background and Aims: Endoluminal functional luminal imaging probe (EndoFLIP) is an imaging tool that measures the physiologic characteristics of GI sphincters. In this study, we used EndoFLIP to evaluate the association between the pyloric physiologic measurements and the dinical outcomes of gastric peroral endoscopic myotomy (G-POEM) in patients with refractory gastroparesis.Methods: Thirty-seven patients from 5 centers who underwent G-POEM for management of refractory gastroparesis and had EndoFLIP measurements were evaluated. Cross-sectional area (CSA), balloon pressure, and the distensibility index (DI) of the pylorus were evaluated by EndoFLIP at 40 mL and 50 mL balloon fills before and after G-POEM. One-year dinical success and change in gastric emptying study 3 months after the G-POEM procedure were compared with the EndoFLIP measurements.Results: Clinical success was achieved in 26 (70%) patients. Post-G-POEM CSA and DI were significantly higher in the clinical success group with both 40-mL volume distension (CSA: 89.9 +/- 64.8 vs 172.5 +/- 71.9 mm(2), P =.003; DI: 5.8 +/- 4.4 vs 8.8 +/- 6.1 mm(2)/mm Hg, P =.043) and 50-mL volume distention (CSA: 140.1 +/- 89.9 vs 237.5 +/- 80.3 mm(2), P =.003; DI: 5.6 +/- 3.3 vs 9.9 +/- 6.6 mm(2)/mm Hg, P =.049). CSA using 40-mL volume distention with an area under the curve of 0.83 yielded a specificity of 91% and a sensitivity of 71% at a cutoff point of 154 mm(2).Conclusions: Post-G-POEM CSA of the pylorus is associated with clinical success and improvement in a gastric emptying scan after G-POEM. EndoFLIP measurements of the pylorus have the potential to be used as a tool to predict the clinical outcome of G-POEM.