Department of Surgery, NorthShore University HealthSystem, Evanston, USA.
Department of Surgery, University of Chicago Medical Center, Chicago, USA.
Surg Endosc. 2021 Aug;35(8):4555-4562. doi: 10.1007/s00464-020-07876-y. Epub 2020 Aug 13.
Peroral endoscopic myotomy (POEM) is a minimally invasive treatment for achalasia. Considerable evidence demonstrates a high incidence of gastroesophageal reflux disease (GERD) after POEM. The endoluminal functional lumen imaging probe (FLIP) uses impedance planimetry to obtain objective measurements of the gastroesophageal junction. This study aims to determine whether FLIP measurements collected at the time of POEM are associated with the development of reflux esophagitis postoperatively.
Patients who underwent POEM between 2012 and 2019 who subsequently had esophagogastroduodenoscopy (EGD) were included. Intraoperative FLIP measurements before and after myotomy, clinical data from EGD, and reflux specific quality of life questionnaires were collected. Comparisons between groups were made using the Wilcoxon rank-sum and Fisher's exact tests. Receiver operating characteristic (ROC) curves were used to determine optimal cutoffs of measurements to classify patients into those with high risk of postoperative esophagitis and those with lower risk.
A total of 43 patients were included. Of those, 25 (58.1%) were found to have esophagitis on postoperative EGD: four patients (16%) with LA Grade A, five (20%) with LA Grade B, 11 (44%) with LA Grade C and two (8%) with LA grade D esophagitis. Patients with a final distensibility index ≥ 2.7 and a final cross-sectional area ≥ 83 were significantly more likely to develop esophagitis on postoperative EGD (p = 0.016 and p = 0.008, respectively). Gastroesophageal reflux disease health-related quality of life (GERD-HRQL) and reflux symptom index (RSI) scores were not significantly different in patients who developed esophagitis and those who did not.
Reflux affects some patients after POEM. We show that FLIP measurements collected during POEM may help predict which patients are more likely to develop reflux esophagitis postoperatively. Subjective symptoms on quality of life questionnaires are not reliable in determining which patients are at risk for esophagitis.
经口内镜下肌切开术（POEM）是治疗贲门失弛缓症的一种微创治疗方法。大量证据表明，POEM 后胃食管反流病（GERD）的发生率相当高。腔内功能腔内腔成像探头（FLIP）使用阻抗平面测量法获得胃食管交界处的客观测量值。本研究旨在确定 POEM 时收集的 FLIP 测量值是否与术后反流性食管炎的发生有关。
纳入 2012 年至 2019 年间接受 POEM 治疗且随后行食管胃十二指肠镜检查（EGD）的患者。收集术中肌切开前后的 FLIP 测量值、EGD 临床资料和反流特异性生活质量问卷。使用 Wilcoxon 秩和检验和 Fisher 确切检验比较组间差异。使用受试者工作特征（ROC）曲线确定测量值的最佳截断值，以将患者分为术后食管炎高风险和低风险组。
共纳入 43 例患者。其中，25 例（58.1%）在术后 EGD 中发现食管炎：4 例（16%）为 LA 分级 A，5 例（20%）为 LA 分级 B，11 例（44%）为 LA 分级 C，2 例（8%）为 LA 分级 D 食管炎。最终可扩张指数≥2.7 和最终横截面积≥83 的患者在术后 EGD 中发生食管炎的可能性显著更高（p=0.016 和 p=0.008）。发生食管炎和未发生食管炎的患者在胃食管反流病健康相关生活质量（GERD-HRQL）和反流症状指数（RSI）评分方面无显著差异。
POEM 后一些患者会出现反流。我们表明，POEM 过程中收集的 FLIP 测量值可能有助于预测哪些患者术后更有可能发生反流性食管炎。生活质量问卷中的主观症状并不可靠，无法确定哪些患者有患食管炎的风险。
