Schnurre Larissa, Murray Fritz Ruprecht, Schindler Valeria, Runggaldier Daniel, Fischbach Lara, Bordier Valentine, Pohl Daniel
Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
Ear, Nose and Throat Department, University Hospital Zurich, Zurich, Switzerland.
Neurogastroenterol Motil. 2020 Sep;32(9):e13864. doi: 10.1111/nmo.13864. Epub 2020 May 11.
Achalasia is a chronic esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter, determined by an elevated integrated relaxation pressure (IRP > 15 mm Hg) and absent peristalsis. Goal of treatment is facilitation of flow across the EGJ but minimizing postinterventional reflux. A new advanced hydraulic dilation technology, the esophageal functional luminal imaging probe (EsoFLIP), allows dynamic monitoring of hollow organ dimensions while performing hydraulic dilation. The aim of our study was to evaluate the treatment response after single EsoFLIP dilation in achalasia patients.
Dilation was performed under endoscopic control with the EsoFLIP device using a self-developed dilation algorithm. Symptom scores were assessed by the Eckardt score (ES) before and 1-4 weeks after intervention. Esophageal emptying before and after intervention was recorded with timed barium esophagogram.
We studied 28 consecutive untreated achalasia patients (8 female) with a median age of 43 years (range 19-82 years) undergoing their first dilation performed with the EsoFLIP, aiming at a maximum dilation diameter of 25 mm. Total ES was significantly reduced from 7 at baseline to 2 postintervention (P < .001). The median height of the barium column after 5 minutes was significantly reduced from 4.5 cm at baseline to 1.7 cm (P = .0087). No major complications occurred.
CONCLUSIONS & INFERENCES: We found good efficacy in both subjective and objective short-term treatment outcome after singular EsoFLIP dilation in treatment-naive achalasia patients. Our findings suggest that EsoFLIP is a promising dilation technology that should be further studied in a larger, controlled setting with longer follow-up.
贲门失弛缓症是一种慢性食管动力障碍性疾病，其特征为食管下括约肌松弛受损，综合松弛压升高（IRP＞15mmHg）且无蠕动。治疗目标是促进食物通过食管胃交界部，但尽量减少介入治疗后的反流。一种新的先进液压扩张技术，即食管功能性腔内成像探头（EsoFLIP），可在进行液压扩张时动态监测中空器官的尺寸。我们研究的目的是评估贲门失弛缓症患者单次EsoFLIP扩张后的治疗反应。
在内镜控制下使用EsoFLIP设备，采用自行研发的扩张算法进行扩张。在干预前及干预后1 - 4周，通过埃卡德特评分（ES）评估症状评分。干预前后的食管排空情况通过定时食管钡餐造影记录。
我们研究了28例未经治疗的连续贲门失弛缓症患者（8例女性），中位年龄43岁（范围19 - 82岁），首次使用EsoFLIP进行扩张，目标最大扩张直径为25mm。总ES从基线时的7分显著降至干预后的2分（P＜0.001）。5分钟后钡柱的中位高度从基线时的4.5cm显著降至1.7cm（P = 0.0087）。未发生重大并发症。
我们发现，在初治的贲门失弛缓症患者中，单次EsoFLIP扩张后的短期主观和客观治疗效果良好。我们的研究结果表明，EsoFLIP是一种有前景的扩张技术，应在更大规模、有对照且随访时间更长的研究中进一步研究。
