Department of Internal Medicine, Digestive Disease Center and Research Institute, Soonchunhyang University College of Medicine, Bucheon, Korea.
PLoS One. 2020 Jun 9;15(6):e0234295. doi: 10.1371/journal.pone.0234295. eCollection 2020.
The functional lumen imaging probe (FLIP) is a recently developed technique to evaluate the esophagogastric junction (EGJ) distensibility. Unlike timed barium esophagogram (TBE) and high-resolution manometry (HRM), FLIP can be used during peroral endoscopic myotomy (POEM). The aim of this study was to evaluate the association of intraoperative FLIP parameters with clinical outcomes as recorded in a single-center database and to investigate a systematic review of literatures.
We reviewed consecutive patients diagnosed with achalasia and scheduled for POEM between June 2016 and March 2019 in our tertiary referral hospital. All patients underwent intraoperative FLIP assessment during POEM. The final FLIP measurements were compared between the patients with good and poor clinical response. We comprehensively reviewed studies evaluating whether intraoperative FLIP measurements reflected clinical outcomes.
We evaluated 23 patients with achalasia who underwent intraoperative FLIP before and after POEM. Two exhibited poor clinical responses after 3 months (Eckardt scores = 3). The final distensibility index (DI) did not differ significantly between good and poor responders (5.01 [4.52] vs. 4.91 [3.63-6.20] mm2/mmHg at a balloon distension of 50-mL, median [IQR], P = 0.853). The final DI did not differ significantly between post-POEM reflux esophagitis and non-reflux esophagitis groups (6.20 [5.15] vs. 4.23 [1.79] mm2/mmHg at a balloon distension of 50-mL, median [IQR], P = 0.075).
A systematic review of both prospective and retrospective studies including our data indicated that the final intraoperative FLIP measurements did not differ significantly between good and poor responders. Further study with more patients is necessary to explore whether FLIP can predict short- and long-term clinical responses.
功能腔内腔成像探头（FLIP）是一种最近开发的技术，用于评估食管胃结合部（EGJ）的可扩张性。与定时钡食管造影（TBE）和高分辨率测压（HRM）不同，FLIP 可用于经口内镜肌切开术（POEM）期间。本研究的目的是评估术中 FLIP 参数与单中心数据库记录的临床结果之间的关联，并对文献进行系统回顾。
我们回顾了 2016 年 6 月至 2019 年 3 月期间在我们的三级转诊医院接受 POEM 治疗的连续诊断为贲门失弛缓症的患者。所有患者均在 POEM 期间接受术中 FLIP 评估。比较了临床反应良好和不良的患者之间的最终 FLIP 测量值。我们全面回顾了评估术中 FLIP 测量值是否反映临床结果的研究。
我们评估了 23 例接受 POEM 前后术中 FLIP 的贲门失弛缓症患者。2 例患者在 3 个月后（Eckardt 评分 = 3）临床反应不佳。在球囊扩张至 50-mL 时，良好反应者和不良反应者的最终扩张指数（DI）无显著差异（5.01[4.52]vs.4.91[3.63-6.20]mm2/mmHg，中位数[IQR]，P=0.853）。POEM 后反流性食管炎和非反流性食管炎组的最终 DI 无显著差异（球囊扩张至 50-mL 时，6.20[5.15]vs.4.23[1.79]mm2/mmHg，中位数[IQR]，P=0.075）。
对包括我们的数据在内的前瞻性和回顾性研究的系统回顾表明，良好反应者和不良反应者之间的最终术中 FLIP 测量值无显著差异。需要进一步研究更多患者以探讨 FLIP 是否可以预测短期和长期临床反应。
