EndoFLIP assessment of pyloric sphincter in children: a single-center experience.

IF 3 4区医学 Q1 Medicine

Translational gastroenterology and hepatology Pub Date : 2023-01-01 DOI:10.21037/tgh-22-58

Mara Popescu, Emily White, Mohamed Mutalib

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引用次数: 2

Abstract

Background: Gastrointestinal complaints are common in children with neurodisabilities, vomiting, retching and poor feed tolerance are frequently reported. Endolumenal functional lumen imaging probe (EndoFLIP) is used to assess compliance and distensibility of the pylorus and can predict response to Botulinum Toxin in adult with gastroparesis. We aimed to review pyloric muscle measurements using EndoFLIP in children with neuromuscular disabilities and significant foregut symptoms and to assess the clinical response to intrapyloric Botulinum Toxin.

Methods: Retrospective review of clinical notes of all children who underwent pyloric EndoFLIP assessment in Evelina London Children's Hospital from March 2019 to January 2022. EndoFLIP catheter was inserted at the time of endoscopy via existing gastrostomy tract.

Results: A total of 335 measurement from 12 children were obtained, mean age 10.7±4.2 years. Measurements (pre and post Botox) were obtained with 20, 30 and 40 mL balloon volume. Diameter (6.5, 6.6), (7.8, 9.4) and (10.1, 11.2), compliance (92.3, 147.9), (89.7, 142.9) and (77, 85.4) mm³/mmHg, distensibility (2.6, 3.8), (2.7, 4.4) and (2.1, 3) mm²/mmHg and balloon pressure was (13.6, 9.6), (20.9, 16.2) and (42.3, 35) mmHg. Eleven children reported clinical symptom improvement after Botulinum Toxin injection. Balloon pressure was positively correlated to diameter (r=0.63, P<0.001).

Conclusions: Children with neurodisabilities who present with symptoms suggestive of poor gastric emptying do have a low pyloric distensibility and poor compliance. EndoFLIP via existing gastrostomy tract is quick and easy to perform. Intrapyloric Botulinum Toxin appears to be safe and effective in this cohort of children leading to clinical and measurements improvement.

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儿童幽门括约肌内窥镜评估:单中心经验。

背景:胃肠道主诉在神经障碍儿童中很常见，呕吐、干呕和食物耐受性差经常被报道。内镜功能管腔成像探针(EndoFLIP)用于评估幽门的顺应性和扩张性，并可预测成人胃轻瘫患者对肉毒杆菌毒素的反应。我们的目的是回顾使用EndoFLIP在患有神经肌肉残疾和明显前肠症状的儿童中进行幽门肌测量，并评估幽门内肉毒杆菌毒素的临床反应。方法:回顾性分析2019年3月至2022年1月在Evelina伦敦儿童医院接受幽门内窥镜检查的所有儿童的临床记录。EndoFLIP导管在内镜检查时通过现有胃造口道插入。结果:共获得12例患儿335次测量，平均年龄10.7±4.2岁。测量(肉毒杆菌注射前和注射后)用20ml、30ml和40ml球囊容积获得。直径(6.5,6.6)，(7.8,9.4)和(10.1,11.2)，顺应性(92.3,147.9)，(89.7,142.9)和(77,85.4)mm3/mmHg，膨胀性(2.6,3.8)，(2.7,4.4)和(2.1,3)mm2/mmHg，球囊压力为(13.6,9.6)，(20.9,16.2)和(42.3,35)mmHg。11例儿童报告注射肉毒杆菌毒素后临床症状改善。球囊压力与球囊直径呈正相关(r=0.63, p)。结论:出现胃排空不良症状的神经功能障碍儿童幽门扩张度低，依从性差。EndoFLIP通过现有的胃造口道进行，快速简便。在这组儿童中，幽门内肉毒杆菌毒素似乎是安全有效的，导致临床和测量的改善。

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来源期刊

Translational gastroenterology and hepatology Medicine-Gastroenterology

CiteScore

8.20

自引率

0.00%

发文量

期刊介绍： Translational Gastroenterology and Hepatology (Transl Gastroenterol Hepatol; TGH; Online ISSN 2415-1289) is an open-access, peer-reviewed online journal that focuses on cutting-edge findings in the field of translational research in gastroenterology and hepatology and provides current and practical information on diagnosis, prevention and clinical investigations of gastrointestinal, pancreas, gallbladder and hepatic diseases. Specific areas of interest include, but not limited to, multimodality therapy, biomarkers, imaging, biology, pathology, and technical advances related to gastrointestinal and hepatic diseases. Contributions pertinent to gastroenterology and hepatology are also included from related fields such as nutrition, surgery, public health, human genetics, basic sciences, education, sociology, and nursing.