Destro Francesca, Costanzo Sara, Durante Eleonora, Carcassola Maria Sole, Meroni Milena, Brunero Marco, Riccio Angela, Calcaterra Valeria, Pelizzo Gloria
Department of Pediatric Surgery, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy.
Department of Pediatrics, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy.
Children (Basel). 2022 Sep 20;9(10):1426. doi: 10.3390/children9101426.
Long term follow-up of patients with esophageal atresia (EA) may be hampered by esophageal dysmotility, which affects quality of life and might lead to late complications. The endoluminal functional lumen imaging probe (EndoFlip™ Medtronic, Crospon Inc.) is an innovative diagnostic tool that assesses esophageal distensibility. Our aim was to report the use of EndoFlip™ in an EA follow-up, in order to describe distensibility patterns and to determine its possible role for functional evaluation of patients. We retrospectively collected data of EA patients, with a minimum follow-up of 9 years, who required endoscopic evaluation and underwent EndoFlip™. An adaptation of the Medtronic EF-322 protocol was applied and distensibility data were compared to those reported by Pandolfino et al. Nine patients (median age 13 years) were included in the study. The median minimum distensibility was 2.58 mm/mmHg. Signs of peristalsis were observed in three patients. In one case, the esophagogastric junction (EGJ) after Toupet fundoplication showed low distensibility. EGJ distensibility values of 2.58 mm/mmHg (median) confirmed both good esophagogastric continence and compliance. Esophagitis and absent peristalsis were found in one patient together with partial stenosis of the fundoplication, confirming the importance of surgical adaptation. Esophageal body distensibility was higher than that of the EGJ. Considering the presence of symptoms, the EndoFlip™ results seem to correlate better with the clinical picture. EndoFlip™ use was safe and feasible in children. It allowed for the measurement of esophageal distensibility and diameter and the acquisition of indirect information on motility with clinical implications. The routine use of EndoFlip™ could be part of EA follow-up, although considerable research is needed to correlate Endoflip™ system measurements to EA patient outcomes.
食管闭锁（EA）患者的长期随访可能会受到食管动力障碍的阻碍，这会影响生活质量并可能导致晚期并发症。腔内功能性管腔成像探头（EndoFlip™，美敦力公司，克罗斯朋公司）是一种评估食管扩张性的创新诊断工具。我们的目的是报告EndoFlip™在EA随访中的应用，以描述扩张性模式并确定其在患者功能评估中的可能作用。我们回顾性收集了EA患者的数据，这些患者至少随访9年，需要进行内镜评估并接受了EndoFlip™检查。应用了美敦力EF - 322方案的改编版，并将扩张性数据与潘多尔菲诺等人报告的数据进行了比较。9名患者（中位年龄13岁）纳入研究。最小扩张性的中位数为2.58 mm/mmHg。在3名患者中观察到蠕动迹象。在1例中，Toupet胃底折叠术后的食管胃交界（EGJ）显示扩张性较低。EGJ扩张性值为2.58 mm/mmHg（中位数）证实了良好的食管胃节制和顺应性。在1名患者中发现食管炎且无蠕动，同时胃底折叠术存在部分狭窄，证实了手术适应性的重要性。食管体部的扩张性高于EGJ。考虑到症状的存在，EndoFlip™的结果似乎与临床情况相关性更好。EndoFlip™在儿童中使用安全可行。它能够测量食管扩张性和直径，并获取有关动力的间接信息，具有临床意义。EndoFlip™的常规使用可以成为EA随访的一部分，尽管需要大量研究来将Endoflip™系统测量结果与EA患者的预后相关联。
