The Functional Lumen Imaging Probe Detects Esophageal Contractility Not Observed With Manometry in Patients With Achalasia.
The Functional Lumen Imaging Probe Detects Esophageal Contractility Not Observed With Manometry in Patients With Achalasia.
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DOI：
10.1053/j.gastro.2015.08.005
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发表时间：
2015-12
期刊：
影响因子：
29.4
通讯作者：
Pandolfino JE
中科院分区：
文献类型：
--
作者：
Carlson DA;Lin Z;Kahrilas PJ;Sternbach J;Donnan EN;Friesen L;Listernick Z;Mogni B;Pandolfino JE
功能性管腔成像探头(FliP)可以通过检测标准测压没有观察到的非闭塞性食道收缩来改善失弛缓症亚型的特征。我们的目标是使用翻转地形图评估贲门失弛缓症患者在容量扩张期间的食道收缩。51例治疗不成熟的失弛缓症患者，通过高分辨率食道压力地形图进行分类，并与10名无症状个体(对照组)在内窥镜检查中进行翻转。在逐步扩张过程中，同时测量了袋内压力和16个通道的横截面面积；数据被输出到生成翻转地形图的软件中。通过记录管腔直径缩小的周期来确定食道的收缩能力。食道收缩的进一步特征是传播方向、重复性，并基于它们是闭塞还是非闭塞。10名对照组均检测到食道收缩功能：8/10为重复、顺行、收缩，9/10为闭合性收缩。27%(4/15)的I型失弛缓症患者和65%(18/26)的II型失弛缓症患者有收缩功能，其中9例为闭塞性收缩。所有10名III型失弛缓症患者都检测到了收缩能力；其中8名患者的收缩模式在对照组中没有观察到(重复、逆行收缩)。在失弛缓症患者中，用翻转地形图可以检测到测压没有观察到的食道收缩能力。用翻转地形图检测到的收缩的存在和模式可能代表了病理生理学的变化，例如II型失弛缓症患者的泛食道加压机制。这些发现可能对补充幽门失弛缓症病程预测的附加子分类有意义。
The functional lumen imaging probe (FLIP) could improve characterization of achalasia subtypes by detecting non-occlusive esophageal contractions not observed with standard manometry. We aimed to evaluate for esophageal contractions during volumetric distention in patients with achalasia using FLIP topography. Fifty one treatment-naïve patients with achalasia, defined and sub-classified by high-resolution esophageal pressure topography, and 10 asymptomatic individuals (controls) were evaluated with the FLIP during endoscopy. During stepwise distension, simultaneous intra-bag pressures and 16 channels of cross-sectional areas were measured; data were exported to software that generated FLIP topography plots. Esophageal contractility was identified by noting periods of reduced luminal diameter. Esophageal contractions were further characterized by propagation direction, repetitiveness, and based on whether they were occluding or non-occluding. Esophageal contractility was detected in all 10 controls: 8/10 had repetitive, antegrade, contractions and 9/10 had occluding contractions. Contractility was detected in 27% (4/15) of patients with type I achalasia and 65% (18/26, including 9 with occluding contractions) of patients with type II achalasia. Contractility was detected in all 10 patients with type III achalasia; 8 of these patients had a pattern of contractility not observed in controls (repetitive, retrograde contractions). Esophageal contractility not observed with manometry can be detected in patients with achalasia using FLIP topography. The presence and patterns of contractility detected with FLIP topography may represent variations in pathophysiology, such as mechanisms of pan-esophageal pressurization in patients with type II achalasia. These findings could have implications for additional sub-classification to supplement prediction of the achalasia disease course.