Nishikawa Yohei, Inoue Haruhiro, Tanaka Ippei, Ito Shotaro, Azuma Daisuke, Ushikubo Kei, Yamamoto Kazuki, Okada Hiroki, Toshimori Akiko, Tanabe Mayo, Onimaru Manabu, Ito Takayoshi, Yokoyama Noboru, Shimamura Yuto
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
Dig Endosc. 2025 Feb;37(2):157-166. doi: 10.1111/den.14882. Epub 2024 Jul 17.
The endoscopic pressure study integrated system (EPSIS) is an endoscopic diagnostic system utilized for evaluation of lower esophageal sphincter function. Although previous studies have determined that EPSIS was effective as a tool for the diagnosis of achalasia, it remains uncertain if EPSIS can detect significant changes before and after peroral endoscopic myotomy (POEM), which is the premier treatment for achalasia. This study aimed to evaluate the effectiveness of EPSIS as an objective diagnostic tool for assessing the clinical effect of POEM.
We conducted a retrospective analysis of patients who underwent POEM from January 2022 to December 2023. The patients underwent EPSIS preoperatively and 2 months postoperatively. Intragastric pressure (IGP) parameters, including the maximum IGP, IGP difference, and waveform gradient were compared pre- and post-POEM. These parameters also were compared between two groups: the postoperative gastroesophageal reflux disease (GERD) group and the non-GERD group.
A total of 50 patients were analyzed. The mean maximum IGP was significantly lower postoperatively than preoperatively (15.0 mmHg vs. 19.8 mmHg, P < 0.001). The mean IGP difference and waveform gradient were also significantly lower postoperatively than preoperatively (8.0 mmHg vs. 12.2 mmHg, P < 0.001; and 0.26 mmHg/s vs. 0.43 mmHg/s, P < 0.001, respectively). The mean postoperative waveform gradient was significantly lower in the GERD group (17 patients, 34%) than in the non-GERD group (33 patients, 66%) (0.207 mmHg vs. 0.291 mmHg, P = 0.034).
The results supported the use of EPSIS as an effective diagnostic tool for assessing the effect of POEM.
内镜压力研究集成系统（EPSIS）是一种用于评估食管下括约肌功能的内镜诊断系统。尽管先前的研究已确定EPSIS作为诊断贲门失弛缓症的工具是有效的，但EPSIS能否检测到经口内镜下肌切开术（POEM，贲门失弛缓症的主要治疗方法）前后的显著变化仍不确定。本研究旨在评估EPSIS作为评估POEM临床效果的客观诊断工具的有效性。
我们对2022年1月至2023年12月接受POEM的患者进行了回顾性分析。患者在术前和术后2个月接受EPSIS检查。比较POEM前后的胃内压（IGP）参数，包括最大IGP、IGP差值和波形梯度。还对两组进行了这些参数的比较：术后胃食管反流病（GERD）组和非GERD组。
共分析了50例患者。术后平均最大IGP显著低于术前（15.0 mmHg对19.8 mmHg，P < 0.001）。术后平均IGP差值和波形梯度也显著低于术前（8.0 mmHg对12.2 mmHg，P < 0.001；以及0.26 mmHg/s对0.43 mmHg/s，P分别< 0.001）。GERD组（17例患者，34%）术后平均波形梯度显著低于非GERD组（33例患者，66%）（0.207 mmHg对0.291 mmHg，P = 0.034）。
结果支持将EPSIS用作评估POEM效果的有效诊断工具。
