Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Department of Medicine, Division of Gastroenterology & Hepatology, University of Pennsylvania, Philadelphia, PA, USA.
Dis Esophagus. 2022 Apr 19;35(4). doi: 10.1093/dote/doab077.
Esophagogastric junction outflow obstruction (EGJOO) has a variable disease course. Currently, barium swallow (BaS) and manometric parameters are used to characterize clinically significant EGJOO. The esophagogastric junction distensibility index (EGJ-DI) measured via functional lumen imaging probe (FLIP) can provide complementary information. Our aim was to assess symptom response in patients with EGJOO and an abnormal EGJ-DI after botulinum toxin (BT) treatment.
A prospective cohort study of adults with idiopathic EGJOO was performed from September 2019 to March 2021. Patients with dysphagia underwent upper endoscopy with FLIP. If the EGJ-DI was abnormally low, BT was injected. Data examined included demographics, medical history, endoscopic and FLIP findings, BaS, manometry, and Eckardt score (ES). ES improvement was assessed via paired samples t-test. Pearson's chi-square tests were used to assess for associations.
Of the 20 patients, 75% had an abnormal EGJ-DI and underwent BT injections. Mean ES for patients with abnormal EGJ-DIs significantly improved from baseline to 1, 3, and 6 month follow-up (P-values: 0.01, 0.05, and 0.02, respectively). There was a significant association between an abnormal EGJ-DI with delayed bolus transit and presence of rapid drink challenge panesophageal pressurization on manometry: P = 0.03 and P = 0.03.
This prospective study revealed that an abnormal EGJ-DI can guide BT as assessed via symptomatic response. Additionally, abnormal EGJ-DI measurements were significantly associated with other parameters used previously to determine clinically relevant EGJOO. Larger follow-up studies are warranted to further elucidate guidance for therapy in EGJOO.
食管胃结合部流出道梗阻（EGJOO）的病程多变。目前，钡餐（BaS）和测压参数用于对具有临床意义的 EGJOO 进行特征描述。通过功能腔内成像探头（FLIP）测量的食管胃结合部可扩张性指数（EGJ-DI）可提供补充信息。我们的目的是评估 EGJOO 患者在接受肉毒杆菌毒素（BT）治疗后，EGJ-DI 异常的患者的症状反应。
对 2019 年 9 月至 2021 年 3 月间的特发性 EGJOO 成人患者进行前瞻性队列研究。有吞咽困难症状的患者接受上消化道内镜检查和 FLIP。如果 EGJ-DI 异常降低，则注射 BT。检查的数据包括人口统计学、病史、内镜和 FLIP 结果、BaS、测压和 Eckardt 评分（ES）。采用配对样本 t 检验评估 ES 的改善情况。采用 Pearson's 卡方检验评估相关性。
20 例患者中，75%的患者 EGJ-DI 异常，并接受 BT 注射。EGJ-DI 异常患者的 ES 从基线到 1、3 和 6 个月随访时显著改善（P 值分别为 0.01、0.05 和 0.02）。异常 EGJ-DI 与钡餐检查时的食团通过延迟和测压时快速饮水挑战全食管高压区的存在之间存在显著关联：P 值分别为 0.03 和 0.03。
这项前瞻性研究表明，异常的 EGJ-DI 可以通过症状反应来指导 BT。此外，异常 EGJ-DI 测量值与以前用于确定具有临床意义的 EGJOO 的其他参数显著相关。需要进行更大规模的随访研究，以进一步阐明 EGJOO 治疗的指导原则。
