Yim Brandon, Gregor Lennon, Siwiec Robert M, Al-Haddad Mohammad, Nowak Thomas V, Wo John M
J Neurogastroenterol Motil. 2023 Apr 30;29(2):192-199. doi: 10.5056/jnm22053.
BACKGROUND/AIMS: The functional lumen imaging probe (FLIP) device has been used to assess pyloric dysfunction in patients with gastroparesis. We aim to investigate whether varying FLIP catheter positions affect pyloric FLIP measurements.
Patients undergoing endoscopy for chronic unexplained nausea and vomiting (CUNV) or gastroparesis were prospectively enrolled. FLIP balloon was adjusted for 3 positions within the pylorus: (1) proximal position, 75% of FLIP balloon in the duodenum and 25% in the antrum; (2) middle position, 50% in the duodenum and 50% in the antrum; and (3) distal position, 25% in the duodenum and 75% in the antrum. Pylorus cross-sectional area (CSA), intra-bag pressure (P), and distensibility indices (DI) were measured for 30, 40, and 50-mL balloon volumes. Fluoroscopic images were obtained to confirm FLIP balloon geometry. Data was analyzed separately using FLIP Analytic and customized MATLAB software.
Twenty-two patients with CUNV (n = 4) and gastroparesis (n = 18) were enrolled. Pressures were significantly higher in the proximal position compared to the middle and distal positions. CSA measurements were significantly higher at the proximal and middle positions for 30-mL and 40-mL volume compared to the distal position values. DI values were significantly lower at the proximal positions for 40-mL and 50-mL distensions when compared to the middle and distal positions. Fluoroscopic images confirmed increased balloon bending when placed mostly in the duodenum.
FLIP balloon position within the pylorus directly affects balloon geometry which significantly affects P, CSA, and DI measurements. Standardized pyloric FLIP protocols and balloon design adjustments are needed for the continued application of this technology to the pylorus.
背景/目的：功能性管腔成像探头（FLIP）设备已用于评估胃轻瘫患者的幽门功能障碍。我们旨在研究不同的FLIP导管位置是否会影响幽门FLIP测量值。
前瞻性纳入因慢性不明原因恶心和呕吐（CUNV）或胃轻瘫接受内镜检查的患者。将FLIP球囊在幽门内调整为3个位置：（1）近端位置，FLIP球囊的75%在十二指肠，25%在胃窦；（2）中间位置，50%在十二指肠，50%在胃窦；（3）远端位置，25%在十二指肠，75%在胃窦。在球囊体积为30、40和50 mL时测量幽门横截面积（CSA）、囊内压力（P）和扩张性指数（DI）。获取荧光透视图像以确认FLIP球囊的形态。分别使用FLIP分析软件和定制的MATLAB软件进行数据分析。
纳入22例CUNV患者（n = 4）和胃轻瘫患者（n = 18）。近端位置的压力显著高于中间和远端位置。与远端位置值相比，在30 mL和40 mL体积时，近端和中间位置的CSA测量值显著更高。与中间和远端位置相比，在40 mL和50 mL扩张时，近端位置的DI值显著更低。荧光透视图像证实，当球囊大部分置于十二指肠时，球囊弯曲增加。
FLIP球囊在幽门内的位置直接影响球囊形态，这显著影响P、CSA和DI测量值。为使该技术继续应用于幽门，需要标准化的幽门FLIP方案和球囊设计调整。
