Brunner Stefanie, Lorenz Florian, Dratsch Thomas, Krauss Dolores T, Eckhoff Jennifer A, Schröder Lorenz, Allo Gabriel, Jung Jin-On, Kasper Philipp, Fuchs Hans F, Schroeder Wolfgang, Bruns Christiane J, Goeser Tobias, Chon Seung-Hun
Department of General, Visceral, Cancer and Transplantat Surgery, University Hospital of Cologne, Cologne, Germany.
Department of Gastroenterology and Hepatology, University Hospital of Cologne, Cologne, Germany.
Dis Esophagus. 2025 Jan 7;38(1). doi: 10.1093/dote/doae104.
The most common functional challenge after Ivor-Lewis esophagectomy is delayed emptying of the gastric conduit. One of the primary endoscopic treatment strategies is performing a pyloric dilatation. However, the effects of dilation have never been scientifically proven. A novel method to detect pyloric distensibility (DI) is the endoluminal functional lumen imaging probe (EndoFlip™). The purpose of this study is to analyze the effects of pyloric dilatation using an EndoFlip™ measurement. Forty-nine patients after Ivor-Lewis esophagectomy were included retrospectively from June 2021 to August 2023 at University Hospital Cologne, Germany. All patients suffered from early delayed emptying of the gastric conduit (DGCE). DI was measured before and after endoscopic dilatation using EndoFlip™ at 40, 45, and 50 mL balloon filling. The Student's t-test and Chi-Squared test were used. All tests were two-sided, with statistical significance set at P ≤ 0.05. EndoFlip™ measurement and pyloric dilatation were feasible in all patients and no adverse events were recorded. DI proved to be smaller in patients before dilatation compared to patients after dilatation. For 40, 45, and 50 mL balloon filling, the mean DI was 5.0 versus 10.0, 4.5 versus 9.1, and 4.0 and 7.5 mm2/mmHg before versus after dilatation. The differences were significant in all balloon fillings. Endoscopic dilatation of the pylorus is the primary endoscopic treatment strategy in patients suffering from DGCE. Currently, the success of dilatation can only be measured with clinical data. This study could demonstrate that EndoFlip™ can be used as an additional diagnostic tool to rate the success of pyloric dilatation.
艾弗-刘易斯食管切除术后最常见的功能挑战是胃管道排空延迟。主要的内镜治疗策略之一是进行幽门扩张。然而，扩张的效果从未得到科学证实。一种检测幽门扩张性（DI）的新方法是腔内功能腔成像探头（EndoFlip™）。本研究的目的是使用EndoFlip™测量来分析幽门扩张的效果。2021年6月至2023年8月，德国科隆大学医院对49例接受艾弗-刘易斯食管切除术的患者进行了回顾性研究。所有患者均患有胃管道早期排空延迟（DGCE）。在内镜扩张前后，使用EndoFlip™在球囊填充量为40、45和50 mL时测量DI。采用学生t检验和卡方检验。所有检验均为双侧检验，统计学显著性设定为P≤0.05。EndoFlip™测量和幽门扩张在所有患者中均可行，且未记录到不良事件。与扩张后患者相比，扩张前患者的DI较小。对于4个0、45和50 mL的球囊填充量，扩张前后的平均DI分别为5.0对10.0、4.5对9.1以及4.0对7.5 mm²/mmHg。所有球囊填充量下的差异均具有显著性。对于患有DGCE的患者，幽门内镜扩张是主要的内镜治疗策略。目前，扩张的成功只能通过临床数据来衡量。本研究表明，EndoFlip™可作为评估幽门扩张成功与否的额外诊断工具。
