Inoue Haruhiro, Tanabe Mayo, Shimamura Yuto, Yamamoto Kazuki, Nishikawa Yohei, Ushikubo Kei, Iwasaki Miyuki, Tanaka Hidenori, Tanaka Ippei, Owada Kaori, Abiko Satoshi, Onimaru Manabu, Seewald Stefan
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
Centre of Gastroenterology, Klinik Hirslanden, Zurich, Switzerland.
Dig Endosc. 2025 Mar;37(3):257-265. doi: 10.1111/den.14922. Epub 2024 Sep 22.
The gastroesophageal junction (GEJ) consists of various anatomical components that together form a barrier to prevent reflux of gastric content. This study introduces a novel phase concept to dynamically evaluate the antireflux barrier (ARB) during endoscopy and analyzes its functionality.
We reviewed previously the recorded endoscopic videos of subjects who underwent the endoscopic pressure study integrated system (EPSIS) from February to April 2024 for indications other than gastroesophageal reflux disease symptoms. This device was used as an auxiliary tool to measure intragastric pressure (IGP) during endoscopy with a retroflex view. The ARB dynamic was divided into three phases: Phase I (gastric phase), Phase II (lower esophageal sphincter phase), and Phase III (esophageal clearance phase). We evaluated the morphological changes in the ARB during insufflation using EPSIS.
The median age of the 30 subjects was 58 years (interquartile range [IQR] 46.5-68.8), including 20 men and 10 women. Endoscopic findings and IGPs were recorded during the three phases. In Phase I, at low IGP (median 6.75 mmHg), the gastroesophageal flap valve and longitudinal folds were observed in 80% of cases. In Phase II, at moderate IGP (median 11.8 mmHg), the scope holding sign was observed in 86.7%. In Phase III, at high IGP (median 19 mmHg) inducing belching, peristalsis was observed in 80% of cases with median recovery time of 5 s.
The phase concept provides a valuable framework for understanding the antireflux mechanism. Further research is needed to validate these findings in GEJ disorders and explore correlations with other modalities.
胃食管交界处（GEJ）由多种解剖结构组成，共同形成一道屏障以防止胃内容物反流。本研究引入一种新的阶段概念，在内镜检查期间动态评估抗反流屏障（ARB）并分析其功能。
我们回顾了2024年2月至4月接受内镜压力研究集成系统（EPSIS）检查的受试者的内镜视频记录，这些受试者的检查指征并非胃食管反流病症状。该设备用作辅助工具，在内镜检查采用反转视图时测量胃内压（IGP）。ARB动态分为三个阶段：第一阶段（胃阶段）、第二阶段（食管下括约肌阶段）和第三阶段（食管清除阶段）。我们使用EPSIS评估了充气期间ARB的形态变化。
30名受试者的中位年龄为58岁（四分位间距[IQR]46.5 - 68.8），包括20名男性和10名女性。在三个阶段记录了内镜检查结果和IGP。在第一阶段，低IGP（中位值6.75 mmHg）时，80%的病例观察到胃食管瓣阀和纵襞。在第二阶段，中等IGP（中位值11.8 mmHg）时，86.7%观察到持镜征。在第三阶段，高IGP（中位值19 mmHg）诱发嗳气时，80%的病例观察到蠕动，中位恢复时间为5秒。
阶段概念为理解抗反流机制提供了一个有价值的框架。需要进一步研究以在GEJ疾病中验证这些发现，并探索与其他检查方式的相关性。
