Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Am J Gastroenterol. 2021 Oct 1;116(10):2032-2041. doi: 10.14309/ajg.0000000000001402.
High-resolution manometry (HRM) is generally considered the primary method to evaluate esophageal motility; functional luminal imaging probe (FLIP) panometry represents a novel method to do so and is completed during sedated endoscopy. This study aimed to compare HRM and FLIP panometry in predicting esophageal retention on timed barium esophagram (TBE).
A total of 329 adult patients who completed FLIP, HRM, and TBE for primary esophageal motility evaluation were included. An abnormal TBE was defined by a 1-minute column height >5 cm or impaction of a 12.5-mm barium tablet. The integrated relaxation pressure (IRP) on HRM was assessed in the supine and upright patient positions. Esophagogastric junction (EGJ) opening was evaluated with 16-cm FLIP performed during sedated endoscopy through EGJ-distensibility index and maximum EGJ diameter.
Receiver operating characteristic curves to identify an abnormal TBE demonstrated AUC (95% confidence interval) of 0.79 (0.75-0.84) for supine IRP, 0.79 (0.76-0.86) for upright IRP, 0.84 (0.79-0.88) for EGJ-distensibility index, and 0.88 (0.85-0.92) for maximum EGJ diameter. Logistic regression to predict abnormal TBE showed odds ratios (95% confidence interval) of 1.8 (0.84-3.7) for consistent IRP elevation and 39.7 (16.4-96.2) for reduced EGJ opening on FLIP panometry. Of 40 patients with HRM-FLIP panometry discordance, HRM-IRP was consistent with TBE in 23% while FLIP panometry was consistent with TBE in 78%.
FLIP panometry provided superior detection of esophageal retention over IRP on HRM. However, application of a complementary evaluation involving FLIP panometry, HRM, and TBE may be necessary to accurately diagnose esophageal motility disorders.
高分辨率测压（HRM）通常被认为是评估食管动力的主要方法；功能腔内成像探头（FLIP）测压法是一种新的方法，可在镇静内镜检查期间完成。本研究旨在比较 HRM 和 FLIP 测压法在预测定时钡食管造影（TBE）中的食管滞留。
共纳入 329 例接受 FLIP、HRM 和 TBE 进行原发性食管动力评估的成年患者。异常 TBE 的定义为 1 分钟柱高>5cm 或 12.5mm 钡片嵌顿。HRM 的整合松弛压力（IRP）在仰卧位和直立位患者体位下进行评估。通过在镇静内镜检查期间使用 16cm 的 FLIP 评估食管胃交界处（EGJ）开口，通过 EGJ 扩张指数和最大 EGJ 直径进行评估。
识别异常 TBE 的受试者工作特征曲线显示，仰卧位 IRP 的 AUC（95%置信区间）为 0.79（0.75-0.84），直立位 IRP 为 0.79（0.76-0.86），EGJ 扩张指数为 0.84（0.79-0.88），最大 EGJ 直径为 0.88（0.85-0.92）。预测异常 TBE 的逻辑回归显示，IRP 持续升高的优势比（95%置信区间）为 1.8（0.84-3.7），FLIP 测压法 EGJ 开口减小的优势比为 39.7（16.4-96.2）。在 40 例 HRM-FLIP 测压法不一致的患者中，HRM-IRP 与 TBE 一致的比例为 23%，而 FLIP 测压法与 TBE 一致的比例为 78%。
FLIP 测压法比 HRM-IRP 更能检测到食管滞留。然而，可能需要应用包括 FLIP 测压法、HRM 和 TBE 在内的补充评估来准确诊断食管动力障碍。
