Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan.
Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan.
Acta Gastroenterol Belg. 2022 Jan-Mar;85(1):15-19. doi: 10.51821/85.1.9240.
Sedation impairs full visualization of the esophagogastric junction (EGJ) and Z line (the squamocolumnar junction) during esophagogastroduodenoscopy (EGD). The aim of this study was to determine whether induction of esophageal peristalsis could improve the ability to evaluate the Z line in children and adolescents.
Study 1: Consecutive patients (10-15 years) undergoing EGD with propofol or midazolam sedation were enrolled. The proportion of Z line observed was compared between the two groups. Study 2: The effect of an air infusion near the EGJ following deflation of the stomach to induce esophageal peristalsis was investigated in the patients (15-18 years), undergoing EGD with propofol sedation. The proportion of Z line observed was compared between the stimulated group and control group.
Study 1: 149 patients were evaluated; 87 received propofol (43 boys; average age 13.2 years (range, 10-15)) and 62 received midazolam (30 boys; average age 12.8 years (range, 10-15)). The proportion of the Z line visualized was low but was greater with propofol vs. midazolam sedation (36.8% vs 16.1%, P=0.0059). Study 2: 102 patients were evaluated; 62 had induction of peristalsis (34 boys; average age 16.2 years (range, 15-18)) and 40 controls (20 boys; average age 16.8 years (range, 15-18)). Complete visualization of the Z line achieved in 95% (59 of 62) following induction of peristalsis vs. 37.5% (15 of 40) of controls (P>0.001).
Induction of esophageal peristalsis greatly improved visualization of the Z line during sedated EGD in children and adolescents.
镇静会影响食管胃连接部（EGJ）和 Z 线（鳞柱状交界）在食管胃十二指肠镜检查（EGD）中的完全可视化。本研究的目的是确定诱导食管蠕动是否可以提高儿童和青少年评估 Z 线的能力。
研究 1：连续入组（10-15 岁）接受丙泊酚或咪达唑仑镇静下 EGD 的患者。比较两组 Z 线的观察比例。研究 2：在接受丙泊酚镇静下 EGD 的患者（15-18 岁）中，研究胃排空后在 EGJ 附近充气以诱导食管蠕动的效果。比较刺激组和对照组 Z 线的观察比例。
研究 1：共评估了 149 例患者；87 例接受丙泊酚（43 例男孩；平均年龄 13.2 岁（范围 10-15）），62 例接受咪达唑仑（30 例男孩；平均年龄 12.8 岁（范围 10-15））。Z 线的可视比例较低，但丙泊酚组高于咪达唑仑组（36.8%比 16.1%，P=0.0059）。研究 2：共评估了 102 例患者；62 例诱导蠕动（34 例男孩；平均年龄 16.2 岁（范围 15-18）），40 例对照组（20 例男孩；平均年龄 16.8 岁（范围 15-18））。诱导蠕动后，95%（59/62）的患者完全可见 Z 线，而对照组为 37.5%（15/40）（P>0.001）。
在儿童和青少年镇静状态下进行 EGD 时，诱导食管蠕动可显著改善 Z 线的可视化。
