Theoretical and Applied Mechanics Program, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA.
Kenneth C. Griffin Esophageal Center of Northwestern Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, Illinois, USA.
Neurogastroenterol Motil. 2023 Dec;35(12):e14692. doi: 10.1111/nmo.14692. Epub 2023 Oct 16.
The distal contractile integral (DCI) quantifies the contractile vigor of primary peristalsis on high-resolution manometry (HRM), whereas no such metric exists for secondary peristalsis on functional lumen imaging probe (FLIP) panometry. This study aimed to evaluate novel FLIP metrics of contraction power and displaced volume in asymptomatic controls and a patient cohort.
Thirty-five asymptomatic controls and adult patients (with normal esophagogastric junction outflow/opening and without spasm) who completed HRM and FLIP panometry were included. The patient group also completed timed barium esophagram (TBE). Contraction power (estimate of esophageal work over time) and displaced volume (estimate of contraction-associated fluid flow) were computed from FLIP. HRM was analyzed per Chicago Classification v4.0.
In controls, median (5th-95th percentile) contraction power was 27 mW (10-44) and displaced volume was 43 mL (17-66). 95 patients were included: 72% with normal motility on HRM, 17% with ineffective esophageal motility (IEM), and 12% with absent contractility. Among patients, DCI was significantly correlated with both contraction power (rho = 0.499) and displaced volume (rho = 0.342); p values < 0.001. Both contraction power and displaced volume were greater in patients with normal motility versus IEM or absent contractility, complete versus incomplete bolus transit, and normal versus abnormal retention on TBE; p values < 0.02.
FLIP panometry metrics of contraction power and displaced volume appeared to effectively quantify peristaltic vigor. These novel metrics may enhance evaluation of esophageal motility with FLIP panometry and provide a reliable surrogate to DCI on HRM.
远端收缩积分（DCI）量化了高分辨率测压（HRM）中原发性蠕动的收缩活力，而在功能性腔内成像探头（FLIP）全景测压中则没有用于测量继发性蠕动的收缩活力的指标。本研究旨在评估无症状对照者和患者队列中新型 FLIP 收缩力和移位体积的指标。
共纳入 35 名无症状对照者和完成 HRM 和 FLIP 全景测压的成年患者（食管胃交界处流出/开放正常且无痉挛）。患者组还完成了时间分辨钡餐食管造影（TBE）。从 FLIP 中计算收缩力（估计随时间推移的食管做功）和移位体积（估计收缩相关的流体流动）。HRM 按照芝加哥分类 v4.0 进行分析。
在对照者中，收缩力的中位数（5 至 95 百分位数）为 27mW（10 至 44），移位体积为 43mL（17 至 66）。共纳入 95 例患者：72%的患者 HRM 运动正常，17%的患者无效食管动力（IEM），12%的患者无收缩力。在患者中，DCI 与收缩力（rho=0.499）和移位体积（rho=0.342）均显著相关；p 值均<0.001。与 IEM 或无收缩力、完全与不完全的食团通过、TBE 正常与异常滞留相比，运动正常的患者收缩力和移位体积均更大，p 值均<0.02。
FLIP 全景测压的收缩力和移位体积指标似乎能够有效地量化蠕动活力。这些新型指标可能会增强 FLIP 全景测压对食管动力的评估，并为 HRM 上的 DCI 提供可靠的替代指标。
