Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.
Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA.
Surg Endosc. 2022 Jul;36(7):4764-4770. doi: 10.1007/s00464-021-08817-z. Epub 2021 Oct 28.
Endoluminal functional lumen imaging probe (EndoFLIP) provides an objective measure of the distensibility index (DI) during different parts of hiatal hernia repair. However, the absolute DI measure above a cut-off after creating a barrier alone has not shown a relationship to dysphagia after surgery. We wanted to determine if the change in DI with volume change is associated with dysphagia.
We included patients who had hiatal hernia repair with EndoFLIP values, including two values taken at the end of the surgical case with different volumes of fluid in the balloon (30 mL and 40 mL). We compared the absolute and change in DI during hiatal hernia repair and performed an analysis to determine if there was a correlation with short-term clinical outcomes.
A total of 103 patients met the inclusion and exclusion criteria. Most of the patients underwent Toupet fundoplication (n = 56, 54%), followed by magnetic sphincter augmentation (LINX, n = 28, 27%) and Nissen fundoplication (n = 19, 18%). There was a significant reduction in the DI from the initial DI taken after mobilization of the hiatus (3 mm/mmHg) and after the creation of the barrier (1.4 mm/mmHg, p < 0.001). A minority of patients had a decrease or no change in the DI with an increase in balloon volume increased from 30 to 40 mL (n = 37, 36%). Overall, after 1 month, there was a significant decrease in the GERD-HRQL score from 23 to 4 (p < 0.001) and bloat score from 3 to 2 (p = 0.003) with a non-significant decrease in the dysphagia score from 1 to 0 (p = 0.11). Patients who had a decreased or unchanged DI with an increase in the balloon volume from 30 to 40 mL had a significant decrease in their dysphagia score by 2 points (p = 0.04).
The decreased or unchanged DI with an increase in the balloon volume on EndoFLIP is associated with a significant reduction in dysphagia after surgery. The decrease in DI denotes the esophagus's ability to create higher pressure relative to the change in the cross-sectional area with a larger bolus across the gastroesophageal junction. This measure may be a new marker that can predict short-term outcomes in patients undergoing hiatal hernia repair.
腔内功能管腔成像探头（EndoFLIP）可提供食管裂孔疝修补术不同部位的扩张指数（DI）的客观测量值。然而，单独创建屏障后超过临界值的绝对 DI 测量值与手术后吞咽困难之间并未显示出相关性。我们想确定 DI 随体积变化的变化是否与吞咽困难有关。
我们纳入了接受过 EndoFLIP 值评估的食管裂孔疝修补术患者，包括在手术结束时使用球囊内不同体积的液体（30 毫升和 40 毫升）时获得的两个值。我们比较了食管裂孔疝修补术中的绝对 DI 和变化，并进行了分析以确定其与短期临床结果是否存在相关性。
共有 103 名患者符合纳入和排除标准。大多数患者接受了 Toupet 胃底折叠术（n=56，54%），其次是磁括约肌增强术（LINX，n=28，27%）和 Nissen 胃底折叠术（n=19，18%）。从 hiatus 松解后获得的初始 DI（3 mm/mmHg）和创建屏障后（1.4 mm/mmHg，p<0.001），DI 显著降低。少数患者在球囊体积从 30 增加到 40 毫升时，DI 减少或不变（n=37，36%）。总体而言，术后 1 个月，GERD-HRQL 评分从 23 降至 4（p<0.001），饱胀评分从 3 降至 2（p=0.003），吞咽困难评分从 1 降至 0 （p=0.11）无显著变化。球囊体积从 30 增加到 40 毫升时，DI 减少或不变的患者，其吞咽困难评分降低 2 分（p=0.04）。
EndoFLIP 上球囊体积增加时 DI 减少或不变与术后吞咽困难显著减轻有关。DI 的减少表示食管相对于胃食管交界处横截面面积的变化，能够产生更高的压力。该测量值可能是预测食管裂孔疝修补术患者短期结局的新标志物。
