Carlson Dustin A, Pandolfino John E, Yadlapati Rena, Vela Marcelo F, Spechler Stuart J, Schnoll-Sussman Felice H, Lynch Kristle, Lazarescu Adriana, Khan Abraham, Katz Philip, Jain Anand S, Gyawali C Prakash, Gupta Milli, Garza Jose M, Fass Ronnie, Clarke John O, Chokshi Reena V, Chen Joan, Ravi Karthik, Chan Walter W, Sultan Shahnaz, Konda Vani J A
Kenneth C. Griffin Esophageal Center of Northwestern Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Kenneth C. Griffin Esophageal Center of Northwestern Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Gastroenterology. 2025 Jun;168(6):1114-1127.e5. doi: 10.1053/j.gastro.2025.01.234. Epub 2025 Feb 4.
BACKGROUND & AIMS: Functional lumen imaging probe (FLIP) panometry provides assessment of the esophagogastric junction opening and esophageal body contractile activity during an endoscopic procedure and is increasingly being incorporated into comprehensive esophageal motility assessments. The aim of this study was to provide a standardized approach and vocabulary to the procedure and interpretation and update the motility classification scheme. METHODS: A working group of 19 FLIP panometry experts convened in a modified Delphi consensus process to produce and assess statements on the FLIP panometry procedure and interpretation. Three rounds of voting were conducted on an agreement scale of 1-9 for appropriateness, followed by face-to-face discussions and an opportunity for revisions of statements. The "percent agreement" was the proportion of votes with score ≥7 indicating level of agreement on appropriateness. RESULTS: A total of 40 statements were selected for final inclusion in the Dallas Consensus, including FLIP panometry protocol, interpretation of esophagogastric junction opening and contractile response, and motility classification scheme. Key statements included: "FLIP panometry should be interpreted in the context of the clinical presentation, the accompanying EGD [esophagogastroduodenoscopy] findings and other relevant complementary testing" (median response 9.0; 100% agreement). "A major motor disorder is unlikely in the setting of a 'normal' FLIP panometry classification" (median response 9.0; 94% agreement). "Diminished or absent contractile response with reduced esophageal opening (ie, nonspastic obstruction) supports the diagnosis of a disorder of EGJ [esophagogastric junction] outflow" (median response 8.5; 94% agreement). CONCLUSIONS: The standardized approach for performance and interpretation of the Dallas Consensus can facilitate use of FLIP panometry in broad clinical settings.
背景与目的:功能性管腔成像探头(FLIP)测压法可在内镜检查过程中评估食管胃交界处开口及食管体部收缩活动,且越来越多地被纳入全面的食管动力评估中。本研究旨在为该检查及解读提供标准化方法和术语,并更新动力分类方案。 方法:19名FLIP测压法专家组成的工作组以改良的德尔菲共识程序召开会议,以制定并评估关于FLIP测压法检查及解读的声明。就适宜性在1-9的同意量表上进行三轮投票,随后进行面对面讨论并有机会对声明进行修订。“同意百分比”是得分≥7的票数所占比例,表明对适宜性的同意程度。 结果:共40条声明被最终纳入《达拉斯共识》,包括FLIP测压法方案、食管胃交界处开口及收缩反应的解读以及动力分类方案。关键声明包括:“FLIP测压法应结合临床表现、同时进行的食管胃十二指肠镜检查(EGD)结果及其他相关补充检查进行解读”(中位反应9.0;100%同意)。“在FLIP测压法分类‘正常’的情况下,不太可能存在主要运动障碍”(中位反应9.0;94%同意)。“食管开口减小且收缩反应减弱或消失(即非痉挛性梗阻)支持食管胃交界处(EGJ)流出道障碍的诊断”(中位反应8.5;94%同意)。 结论:《达拉斯共识》中关于操作和解读的标准化方法有助于在广泛的临床环境中使用FLIP测压法。
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