Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain.
Dig Endosc. 2021 Jul;33(5):780-787. doi: 10.1111/den.13867. Epub 2020 Dec 8.
Endoscopic pressure study integrated system (EPSIS) is a novel diagnostic tool for gastroesophageal reflux disease (GERD). EPSIS has been developed to evaluate lower esophageal sphincter function by monitoring the intragastric pressure (IGP) while insufflating the stomach during gastroscopy. Based on previous data, EPSIS could diagnose GERD with good accuracy by assessing IGP waveform pattern. This study aimed to further characterize the waveform to improve the diagnostic yield of EPSIS.
We conducted a retrospective analysis of patients with typical GERD symptoms who underwent both EPSIS and 24-h impedance-pH monitoring (MII-pH) at a single tertiary referral center from October 2018 to May 2020. EPSIS was performed by using a through-the-scope catheter connected to the pressure measuring system (TR-W550, TR-TeH08, AP-C35; Keyence, Osaka, Japan) to monitor IGP. Abnormal acid reflux was defined as acid exposure time (AET) over 6.0%. Pressure waveform was characterized as follows: (i) Basal IGP, (ii) Maximum IGP, (iii) Pressure difference, (iv) Gradient of the waveform.
A total of 57 patients with GERD symptoms were analyzed. Twenty-one patients presented abnormal AET on MII-pH. Among EPSIS parameters, pressure difference during insufflation correlated with AET (ρ = -0.66, P < 0.01) and showed the best diagnostic accuracy for AET with the cutoff value of 4.7 mmHg (area under the curve [AUC], 0.87). The gradient of EPSIS waveform also revealed good diagnostic accuracy for abnormal AET with the cutoff value of 0.07 mmHg/s (AUC, 0.81).
Endoscopic pressure study integrated system waveform parameters, especially pressure difference, presented high diagnostic accuracy for the presence of abnormal acid reflux.
内镜压力研究集成系统（EPSIS）是一种用于胃食管反流病（GERD）的新型诊断工具。EPSIS 的开发是为了通过在胃镜检查时向胃内充气的同时监测胃内压力（IGP）来评估食管下括约肌功能。基于之前的数据，通过评估 IGP 波形模式，EPSIS 可以很好地准确诊断 GERD。本研究旨在进一步对波形进行特征分析，以提高 EPSIS 的诊断效果。
我们对 2018 年 10 月至 2020 年 5 月在一家三级转诊中心同时接受 EPSIS 和 24 小时阻抗-pH 监测（MII-pH）的具有典型 GERD 症状的患者进行了回顾性分析。EPSIS 通过使用连接到压力测量系统（TR-W550、TR-TeH08、AP-C35；Keyence，大阪，日本）的经内镜导管进行，以监测 IGP。异常酸反流定义为酸暴露时间（AET）超过 6.0%。压力波形特征如下：（i）基础 IGP，（ii）最大 IGP，（iii）压力差，（iv）波形梯度。
共分析了 57 例 GERD 症状患者。21 例患者在 MII-pH 上表现出异常 AET。在 EPSIS 参数中，充气过程中的压力差与 AET 相关（ρ=-0.66，P<0.01），并且具有 4.7mmHg 的截断值时对 AET 具有最佳诊断准确性（曲线下面积 [AUC]，0.87）。EPSIS 波形的梯度也显示出对异常 AET 具有良好的诊断准确性，截断值为 0.07mmHg/s（AUC，0.81）。
内镜压力研究集成系统波形参数，特别是压力差，对异常酸反流的存在具有较高的诊断准确性。
