Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Gastroenterology Department, Dupuytren University Hospital, Limoges, France.
Gastrointest Endosc. 2020 Jun;91(6):1289-1299. doi: 10.1016/j.gie.2020.01.044. Epub 2020 Feb 6.
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 clinical outcomes of gastric peroral endoscopic myotomy (G-POEM) in patients with refractory gastroparesis.
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 clinical success and change in gastric emptying study 3 months after the G-POEM procedure were compared with the EndoFLIP measurements.
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, P =.003; DI: 5.8 ± 4.4 vs 8.8 ± 6.1 mm/mm Hg, P =.043) and 50-mL volume distention (CSA: 140.1 ± 89.9 vs 237.5 ± 80.3 mm, P =.003; DI: 5.6 ± 3.3 vs 9.9 ± 6.6 mm/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.
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.
腔内功能腔内成像探头（EndoFLIP）是一种测量 GI 括约肌生理特征的成像工具。本研究使用 EndoFLIP 评估了幽门生理测量值与胃经口内镜肌切开术（G-POEM）治疗难治性胃轻瘫患者的临床结果之间的关系。
来自 5 个中心的 37 例接受 G-POEM 治疗难治性胃轻瘫并进行 EndoFLIP 测量的患者进行了评估。在 G-POEM 前后，使用 EndoFLIP 在 40mL 和 50mL 球囊充盈时评估幽门的横截面积（CSA）、球囊压力和可扩张指数（DI）。将 G-POEM 术后 3 个月的胃排空研究的 1 年临床成功率与 EndoFLIP 测量值进行比较。
26 例（70%）患者获得临床成功。在临床成功组中，40mL 容量扩张后的 CSA 和 DI 均显著升高（CSA：89.9±64.8 与 172.5±71.9mm，P=.003；DI：5.8±4.4 与 8.8±6.1mm/mm Hg，P=.043）和 50mL 容量扩张（CSA：140.1±89.9 与 237.5±80.3mm，P=.003；DI：5.6±3.3 与 9.9±6.6mm/mm Hg，P=.049）。CSA 使用 40mL 体积膨胀的曲线下面积为 0.83，在 154mm 的截定点处具有 91%的特异性和 71%的灵敏度。
G-POEM 后幽门 CSA 与 G-POEM 后临床成功和胃排空扫描改善相关。幽门的 EndoFLIP 测量值有可能成为预测 G-POEM 临床结果的工具。
