Fujiyoshi Yusuke, Inoue Haruhiro, Shimamura Yuto, Fujiyoshi Mary Raina Angeli, de Santiago Enrique Rodriguez, Nishikawa Yohei, Toshimori Akiko, Tanabe Mayo, Sumi Kazuya, Ono Masashi, Iwaya Yugo, Ikeda Haruo, Onimaru Manabu
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.
Endosc Int Open. 2022 Jun 10;10(6):E762-E768. doi: 10.1055/a-1790-6141. eCollection 2022 Jun.
The endoscopic pressure study integrated system (EPSIS), a novel diagnostic tool for gastroesophageal reflux disease (GERD), allows evaluation of the anti-reflux barrier using endoscopy by monitoring the intragastric pressure (IGP) during insufflation. In this study, we evaluated the association between EPSIS results and lower esophageal sphincter (LES) function measured by high-resolution manometry (HRM) to elucidate whether EPSIS can evaluate the LES function. A retrospective, single-center study of patients with GERD symptoms who underwent endoscopy, pH-impedance monitoring, EPSIS, and HRM was conducted. The primary outcome was basal LES pressure and the secondary outcomes were end-respiratory LES pressure and integrated relaxation pressure (IRP). As EPSIS parameters, the following were measured: 1) pressure difference (mmHg), the difference between maximum and basal IGP; and 2) pressure gradient (mmHg/s), calculated by dividing pressure difference by the insufflating time. Pressure difference < 4.7 mmHg or pressure gradient < 0.07 mmHg/s was defined as an EPSIS GERD pattern. Forty-seven patients (median age: 53 years, 37 female) were analyzed. Pressure difference and pressure gradient significantly correlated with basal LES pressure (ρ = 0.29; 0.04 and ρ = 0.29; 0.04). Patients with EPSIS GERD pattern showed significantly lower basal LES pressure [13.2 (4.8-26.6) vs 25.3 (10.4-66.7) mmHg, 0.002], lower end-respiratory LES pressure [8.5 (1.1-15.9) vs 15.5 (1.9-43.9) mmHg, 0.019] and lower IRP [5.9 (1.0-12.0) vs 9.8 (1.3-17.8) mmHg, 0.020]. This study showed a close association between EPSIS results and LES pressures measured by HRM. This indicates that EPSIS can evaluate the LES function during endoscopy and endorse the role of EPSIS as a diagnostic tool for GERD.
内镜压力研究集成系统（EPSIS）是一种用于诊断胃食管反流病（GERD）的新型工具，它通过在内镜检查过程中监测胃内压力（IGP）来评估抗反流屏障。在本研究中，我们评估了EPSIS结果与通过高分辨率测压法（HRM）测量的食管下括约肌（LES）功能之间的关联，以阐明EPSIS是否能够评估LES功能。我们对有GERD症状且接受了内镜检查、pH阻抗监测、EPSIS和HRM的患者进行了一项回顾性单中心研究。主要结局指标是LES基础压力，次要结局指标是呼气末LES压力和综合松弛压力（IRP）。作为EPSIS参数，测量了以下指标：1）压力差（mmHg），即最大IGP与基础IGP之间的差值；2）压力梯度（mmHg/s），通过将压力差除以充气时间计算得出。压力差<4.7 mmHg或压力梯度<0.07 mmHg/s被定义为EPSIS GERD模式。分析了47例患者（中位年龄：53岁，37例女性）。压力差和压力梯度与LES基础压力显著相关（ρ = 0.29；P = 0.04和ρ = 0.29；P = 0.04）。具有EPSIS GERD模式的患者显示出显著更低的LES基础压力[13.2（4.8 - 26.6） vs 25.3（10.4 - 66.7）mmHg，P = 0.002]、更低的呼气末LES压力[8.5（1.1 - 15.9） vs 15.5（1.9 - 43.9）mmHg，P = 0.019]和更低的IRP[5.9（1.0 - 12.0） vs 9.8（1.3 - 17.8）mmHg，P = 0.020]。本研究表明EPSIS结果与通过HRM测量的LES压力之间存在密切关联。这表明EPSIS能够在内镜检查期间评估LES功能，并认可EPSIS作为GERD诊断工具的作用。
