Department of Gastroenterology, Oslo University Hospital, Oslo, Norway.
Faculty of Medicine, University of Oslo, Oslo, Norway.
Surg Endosc. 2023 Dec;37(12):9283-9290. doi: 10.1007/s00464-023-10494-z. Epub 2023 Oct 25.
The functional luminal imaging probe (FLIP) can provide measurements of lower esophageal sphincter (LES) distensibility. Studies report that use of intraoperative FLIP examination during peroral endoscopic myotomy (POEM) for achalasia is associated with treatment success, but evidence is limited and inconsistent. The main aim of the present study was to assess associations between intraoperative FLIP values and 1-year outcomes. Additionally, associations between 1-year FLIP measurements and other 1-year outcome variables were studied.
We performed a single-center prospective study of consecutive achalasia patients treated with POEM with a standardized 1-year follow-up. The inclusion period was from June 2017 to January 2020. We compared 1-year outcomes (FLIP measurement values, Eckardt score (ES), reflux esophagitis, timed barium esophagogram (TBE), and lower esophageal sphincter resting pressure (LES-rp)) in patients with and without intraoperative FLIP examination. We also assessed associations between intraoperative FLIP values, 1-year FLIP values, and other 1-year outcomes. Results are given as median (IQR), and non-parametrical statistical analyses were applied.
Sixty-two patients (27 females) with median age 45 years (35-54) were included. Baseline characteristics were similar in patients with (n = 32) and without (n = 30) intraoperative FLIP examination. In patients with intraoperative FLIP, ES was 2 (1-3) and LES distensibility index (DI) 3.7 (2.6-5.4) after 1 year, compared with ES 2 (1-3) and DI 4.0 (3.1-6.8)) in patients without intraoperative FLIP (ns). Intraoperative DI was not correlated with 1-year ES or DI. One-year DI correlated significantly with 1-year ES (r - 0.42), TBE (r - 0.34), and LES-rp (r - 0.29).
Use of intraoperative FLIP measurements in POEM for achalasia is not associated with improved 1-year outcome, and the clinical value of intraoperative FLIP in POEM for achalasia is questioned. Follow-up FLIP measurements are moderately associated with symptomatic outcome, and may serve as an additional diagnostic modality in post-treatment evaluation.
功能腔内成像探针（FLIP）可提供食管下括约肌（LES）顺应性的测量。研究报告称，在贲门失弛缓症的经口内镜肌切开术（POEM）中使用术中 FLIP 检查与治疗成功相关，但证据有限且不一致。本研究的主要目的是评估术中 FLIP 值与 1 年结果之间的关联。此外，还研究了 1 年 FLIP 测量值与其他 1 年结果变量之间的关系。
我们对 2017 年 6 月至 2020 年 1 月期间接受 POEM 治疗的连续贲门失弛缓症患者进行了一项单中心前瞻性研究，并进行了标准化的 1 年随访。纳入期为 2017 年 6 月至 2020 年 1 月。我们比较了术中无 FLIP 检查患者（n=30）和术中有 FLIP 检查患者（n=32）的 1 年结果（FLIP 测量值、Eckardt 评分（ES）、反流性食管炎、时间分辨钡食管造影（TBE）和食管下括约肌静息压（LES-rp））。我们还评估了术中 FLIP 值、1 年 FLIP 值与其他 1 年结果之间的关系。结果以中位数（IQR）表示，并进行了非参数统计分析。
共纳入 62 例患者（27 例女性），中位年龄为 45 岁（35-54 岁）。术中有 FLIP 检查患者的基线特征与术中无 FLIP 检查患者相似（n=32 与 n=30）。在术中有 FLIP 的患者中，ES 为 2（1-3），LE 顺应性指数（DI）为 3.7（2.6-5.4），而术中无 FLIP 的患者 ES 为 2（1-3），DI 为 4.0（3.1-6.8）（无统计学意义）。术中 DI 与 1 年 ES 或 DI 无相关性。1 年 DI 与 1 年 ES（r=-0.42）、TBE（r=-0.34）和 LES-rp（r=-0.29）显著相关。
在贲门失弛缓症的 POEM 中使用术中 FLIP 测量值与改善 1 年结果无关，术中 FLIP 在 POEM 治疗贲门失弛缓症中的临床价值受到质疑。随访 FLIP 测量值与症状结果中度相关，可作为治疗后评估的附加诊断方法。
