Functional Lumen Imaging Probe as Part of Multimodality Assessment of Esophagogastric Junction Opening Is Important in Longitudinal Follow-Up of Patients With Treated Achalasia.
Amrit K Kamboj, Shubham Sood, Brandon Truong, Louis M Wong Kee Song, Michael Wells, Dennis Wigle, D Chamil Codipilly, Diana L Snyder, Jeffrey A Alexander, Cadman Leggett, Ryan J Lennon, Andree Koop, Marcelo Vela, Karthik Ravi
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引用次数: 0
Abstract
Background: Functional lumen imaging probe (FLIP) utility is established in treatment-naïve achalasia but less clear following lower esophageal sphincter (LES) directed therapy.
Methods: Achalasia patients with LES directed therapy across three tertiary care centers between 2017 and 2024 with post-treatment FLIP and timed barium esophagram (TBE) were retrospectively identified. Reduced esophagogastric junction (EGJ) opening was defined by distensibility index (DI) < 2 mm2/mmHg and diameter < 12 mm. Abnormal emptying on TBE was defined as column height ≥ 5 cm at 5 min and/or retained tablet. Eckardt scores ≤ 3 defined clinical response.
Key results: The study included 222 patients (46% peroral endoscopic myotomy, 46% laparoscopic Heller myotomy, 8% pneumatic dilation) with a median of 1.4 years to post-treatment TBE/FLIP. Abnormal emptying on TBE was associated with a narrower median EGJ diameter (13.2 vs. 14.8 mm, p = 0.008), a greater frequency of EGJ diameter < 12 mm (36% vs. 21%, p = 0.012), and a smaller change in EGJ diameter (+4.6 vs. +8.6 mm, p = 0.002). Abnormal emptying on TBE occurred more frequently in patients with EGJ DI < 2 mm2/mmHg (8.5% vs. 2.6%, p = 0.052), but was not associated with median EGJ DI (4.5 vs. 5.1 mm2/mmHg, p = 0.29) nor median change in EGJ DI (+2.9 vs. +3.9 mm2/mmHg, p = 0.25). Patients with reduced EGJ DI or EGJ diameter more often had abnormal TBE (37% vs. 22%, p = 0.012). Only the change in DI (+3.8 vs. +1.5 mm2/mmHg, p = 0.012) and diameter (+8.2 vs. +1.6 mm, p = 0.002) on FLIP was associated with a clinical response based on Eckardt ≤ 3.
Conclusions and inferences: FLIP following achalasia therapy generally correlates with TBE, although discrepant findings are not uncommon. In particular, FLIP EGJ-diameter has a strong association with esophageal emptying on TBE. Both TBE and FLIP have limited association with clinical response based on Eckardt, with change in DI and diameter on FLIP most strongly associated. Consequently, FLIP as part of multimodal assessment appears useful in the longitudinal follow-up of treated achalasia.
背景：功能性管腔成像探针（FLIP）在treatment-naïve贲门失弛缓症中的应用已经确立，但在食管下括约肌（LES）定向治疗后效果不明显。方法：回顾性分析2017年至2024年间在三个三级护理中心接受LES定向治疗的贲门失弛缓症患者，治疗后进行FLIP和定时钡食管造影（TBE）。食管胃交界（EGJ）开口减小由扩张指数（DI） 2/mmHg和直径定义。关键结果：研究纳入222例患者（46%经口内窥镜肌切开术，46%腹腔镜Heller肌切开术，8%气动扩张），治疗后TBE/FLIP中位时间为1.4年。TBE异常排空与EGJ直径中位数变窄（13.2 vs. 14.8 mm, p = 0.008）、EGJ直径2/mmHg频率增高（8.5% vs. 2.6%, p = 0.052）相关，但与EGJ DI中位数变化（4.5 vs. 5.1 mm2/mmHg, p = 0.29）和EGJ DI中位数变化（+2.9 vs. +3.9 mm2/mmHg, p = 0.25）无关。EGJ DI或EGJ直径降低的患者更容易出现TBE异常（37%比22%，p = 0.012）。根据Eckardt≤3，只有FLIP的DI （+3.8 vs +1.5 mm2/mmHg, p = 0.012）和直径（+8.2 vs +1.6 mm, p = 0.002）的变化与临床反应相关。结论和推论：贲门失弛缓症治疗后的FLIP通常与TBE相关，尽管差异的发现并不罕见。特别是，FLIP egj直径与TBE上的食道排空密切相关。基于Eckardt， TBE和FLIP与临床反应的相关性都很有限，与FLIP的DI和内径变化相关性最强。因此，FLIP作为多模式评估的一部分，在治疗后贲门失弛缓症的纵向随访中显得很有用。
期刊介绍：
Neurogastroenterology & Motility (NMO) is the official Journal of the European Society of Neurogastroenterology & Motility (ESNM) and the American Neurogastroenterology and Motility Society (ANMS). It is edited by James Galligan, Albert Bredenoord, and Stephen Vanner. The editorial and peer review process is independent of the societies affiliated to the journal and publisher: Neither the ANMS, the ESNM or the Publisher have editorial decision-making power. Whenever these are relevant to the content being considered or published, the editors, journal management committee and editorial board declare their interests and affiliations.
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