Carlson Dustin A, Lin Zhiyue, Kahrilas Peter J, Sternbach Joel, Hungness Eric S, Soper Nathaniel J, Balla Michelle, Listernick Zoe, Tye Michael, Ritter Katherine, Craft Jenna, Ciolino Jody D, Pandolfino John E
Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Am J Gastroenterol. 2016 Dec;111(12):1702-1710. doi: 10.1038/ajg.2016.442. Epub 2016 Oct 4.
We aimed to evaluate the value of novel high-resolution impedance manometry (HRIM) metrics, bolus flow time (BFT), and esophagogastric junction (EGJ) contractile integral (CI), as well as EGJ pressure (EGJP) and the integrated relaxation pressure (IRP), as indicators of treatment response in achalasia.
We prospectively evaluated 75 patients (ages 19-81, 32 female) with achalasia during follow-up after pneumatic dilation or myotomy with Eckardt score (ES), timed-barium esophagram (TBE), and HRIM. Receiver-operating characteristic (ROC) curves for good symptomatic outcome (ES≤3) and good radiographic outcome (TBE column height at 5 min<5 cm) were generated for each potential predictor of treatment response (EGJP, IRP, BFT, and EGJ-CI).
Follow-up occurred at a median (range) 12 (3-291) months following treatment. A total of 49 patients had good symptomatic outcome and 46 had good radiographic outcome. The area-under-the-curves (AUCs) on the ROC curve for symptomatic outcome were 0.55 (EGJP), 0.62 (IRP), 0.77 (BFT) and 0.56 (EGJ-CI). The AUCs for radiographic outcome were 0.64 (EGJP), 0.48 (IRP), 0.73 (BFT), and 0.65 (EGJ-CI). Optimal cut-points were determined as 11 mm Hg (EGJP), 12 mm Hg (IRP), 0 s (BFT), and 30 mm Hg•cm (EGJ-CI) that provided sensitivities/specificities of 57%/46% (EGJP), 65%/58% (IRP), 78%/77% (BFT), and 53%/62% (EGJ-CI) to predict symptomatic outcome and 57%/66% (EGJP), 57%/41% (IRP), 76%/69% (BFT), and 57%/66% (EGJ-CI) to predict radiographic outcome.
BFT, a novel HRIM metric, provided an improved functional assessment over manometric measures of EGJP, IRP, and EGJ-CI at follow-up after achalasia treatment and may help direct clinical management.
我们旨在评估新型高分辨率阻抗测压法（HRIM）指标、团注流动时间（BFT）和食管胃交界部（EGJ）收缩积分（CI），以及EGJ压力（EGJP）和综合松弛压力（IRP）作为贲门失弛缓症治疗反应指标的价值。
我们对75例贲门失弛缓症患者（年龄19 - 81岁，女性32例）在接受气囊扩张或肌切开术后进行随访，采用埃卡德特评分（ES）、定时钡餐食管造影（TBE）和HRIM。针对每个治疗反应的潜在预测指标（EGJP、IRP、BFT和EGJ - CI），生成用于评估良好症状结局（ES≤3）和良好影像学结局（5分钟时TBE柱状高度<5 cm）的受试者操作特征（ROC）曲线。
治疗后随访时间中位数（范围）为12（3 - 291）个月。共有49例患者有良好的症状结局，46例有良好的影像学结局。ROC曲线中症状结局的曲线下面积（AUC）分别为0.55（EGJP）、0.62（IRP）、0.77（BFT）和0.56（EGJ - CI）。影像学结局的AUC分别为0.64（EGJP）、0.48（IRP）、0.73（BFT）和0.65（EGJ - CI）。确定的最佳切点分别为11 mmHg（EGJP）、12 mmHg（IRP）、0 s（BFT）和30 mmHg•cm（EGJ - CI），这些切点预测症状结局的敏感度/特异度分别为57%/46%（EGJP）、65%/58%（IRP）、78%/77%（BFT）和53%/62%（EGJ - CI），预测影像学结局的敏感度/特异度分别为57%/66%（EGJP）、57%/41%（IRP）、76%/69%（BFT）和57%/66%（EGJ - CI）。
BFT作为一种新型HRIM指标，在贲门失弛缓症治疗后的随访中，相较于EGJP、IRP和EGJ - CI的测压指标，能提供更好的功能评估，可能有助于指导临床管理。
