From the Department of Surgery, University of Chicago, Chicago, IL (Amundson, VanDruff, Wu, Campbell).
the Department of Surgery, NorthShore University Health System, Evanston, IL (Amundson, Kuchta, VanDruff, Wu, Campbell, Hedburg, Ujiki).
J Am Coll Surg. 2023 Jul 1;237(1):35-48. doi: 10.1097/XCS.0000000000000675. Epub 2023 Mar 10.
The geometry and compliance of gastrointestinal sphincters may be assessed by impedance planimetry using a functional lumen imaging probe (FLIP). We describe our institutional foregut surgeon experience using FLIP in 1,097 cases, highlighting instances where FLIP changed operative decision making.
A retrospective review of an IRB-approved prospective quality database was performed. This included operative and endoscopic suite foregut procedures using FLIP between February 2013 and May 2022.
During the study period, FLIP was used a total of 1,097 times in 919 unique patients by 2 foregut surgeons. Intraoperative FLIP was used during 573 antireflux procedures and 272 endoscopic myotomies. FLIP was also used during 252 endoscopic suite procedures. For those undergoing preoperative workup of GERD, starting in 2021, esophageal panometry was performed in addition to standard FLIP measurements at the lower esophageal sphincter. In 77 cases, intraoperative FLIP changed operative decision making. During antireflux procedures, changes included adding or removing crural sutures, adjusting a fundoplication tightness, choice of full vs partial wrap, and magnetic sphincter augmentation sizing. For endoscopic procedures, changes included aborting peroral endoscopic myotomy or Zenker's peroral endoscopic myotomy, performing a myotomy when preoperative diagnosis was unclear, or performing additional myotomy.
FLIP is a useful tool for assessing the upper esophageal sphincter, lower esophageal sphincter, pylorus, and secondary esophageal peristalsis that can be used in a wide variety of clinical situations within a foregut surgeon's practice. It can also function as an adjunct in intraoperative decision making.
胃肠括约肌的几何形状和顺应性可以通过使用功能腔成像探头（FLIP）的阻抗平面测量来评估。我们描述了我们机构的前肠外科医生在 1097 例病例中使用 FLIP 的经验，重点介绍了 FLIP 改变手术决策的情况。
对一项经过机构审查委员会批准的前瞻性质量数据库进行了回顾性分析。这包括在 2013 年 2 月至 2022 年 5 月期间使用 FLIP 进行的手术和内镜套房前肠手术。
在研究期间，由 2 位前肠外科医生总共在 919 名患者中使用了 1097 次 FLIP。术中使用 FLIP 进行了 573 次抗反流手术和 272 次内镜肌切开术。FLIP 还用于 252 次内镜套房手术。对于那些接受 GERD 术前评估的患者，从 2021 年开始，除了在下食管括约肌处进行标准的 FLIP 测量外，还进行食管压力测量。在 77 例病例中，术中 FLIP 改变了手术决策。在抗反流手术中，改变包括添加或去除皱襞缝线、调整胃底折叠术的紧度、选择全包裹或部分包裹以及磁性括约肌增强器的尺寸。对于内镜手术，改变包括中止经口内镜肌切开术或Zenker 的经口内镜肌切开术、在术前诊断不明确时进行肌切开术、或进行额外的肌切开术。
FLIP 是一种评估上食管括约肌、下食管括约肌、幽门和继发性食管蠕动的有用工具，可在外科医生的临床实践中广泛应用于各种临床情况。它还可以作为术中决策的辅助工具。
