Miller James D, Mitchell Zachary L, Ellington Abigail L, Peoples Felicia A, Clayton Steven B
Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Section on Gastroenterology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Neurogastroenterol Motil. 2025 Oct;37(10):e70053. doi: 10.1111/nmo.70053. Epub 2025 Apr 24.
Pneumatic dilation (PD) is an effective treatment for disorders of reduced esophageal opening. Functional lumen impedance planimetry (FLIP) can effectively measure lower esophageal sphincter (LES) physiology compared to esophageal standards. The aim of this retrospective cohort analysis was to evaluate if FLIP measurements and esophageal opening classifications changed consistently with symptom improvement post-PD. Also, the aim was to determine if post-PD FLIP measurement correlated with the need for repeat dilation.
Patients with clinically significant esophagogastric junction outlet obstruction (EGJOO) with reduced esophageal opening (REO) or borderline REO (BrEO) based on FLIP, timed barium esophagram (TBE), and manometry who underwent PD were included. Post-PD FLIP measurements were taken immediately after PD during the same endoscopy encounter.
After PD, average distensibility index (DI) increased from 1.5 mm/mmHg to 4.7 mm/mmHg (p < 0.001) and diameter changed from 8.9 mm to 15.9 mm (p < 0.001). Average post-dilation Eckardt score was 1.2, decreasing from an average pre-dilation score of 6.25. Of those requiring repeat dilations, average post-dilation DI was 4.5 mm/mmHg and diameter 16.4 mm, not statistically different from those that did not undergo repeat procedure (p = 0.79, 0.67, respectively). Post-dilation esophageal openings were all NEO or BnEO. Average Eckardt score at 6-8 week follow-up was not significantly different from those who did not require repeat dilation (1.4, p = 0.112).
PD appears to be associated with improved esophageal opening and a significant change in both DI and diameter, consistent with an improved Eckardt score. Post-dilation DI, diameter, esophageal opening pattern, and Eckardt score did not reveal a trend indicating the need for repeat dilation.
气囊扩张术（PD）是治疗食管开口缩小疾病的有效方法。与食管标准相比，功能性管腔阻抗平面测量法（FLIP）能够有效测量食管下括约肌（LES）的生理功能。本回顾性队列分析的目的是评估气囊扩张术后FLIP测量值和食管开口分类是否随症状改善而一致变化。此外，目的是确定气囊扩张术后的FLIP测量值是否与重复扩张的必要性相关。
纳入基于FLIP、定时钡剂食管造影（TBE）和测压法诊断为具有临床意义的食管胃交界部出口梗阻（EGJOO）且食管开口缩小（REO）或临界REO（BrEO）并接受气囊扩张术的患者。气囊扩张术后的FLIP测量值在同一内镜检查过程中于气囊扩张术后立即获取。
气囊扩张术后，平均扩张性指数（DI）从1.5毫米/毫米汞柱增加至4.7毫米/毫米汞柱（p<0.001），直径从8.9毫米变为15.9毫米（p<0.001）。扩张术后平均埃卡德特评分是1.2，较扩张术前平均评分6.25有所降低。在需要重复扩张的患者中，扩张术后平均DI为4.5毫米/毫米汞柱，直径为16.4毫米，与未接受重复操作的患者相比无统计学差异（分别为p = 0.79、0.67）。扩张术后食管开口均为非狭窄性食管开口（NEO）或临界非狭窄性食管开口（BnEO）。6 - 8周随访时的平均埃卡德特评分与不需要重复扩张的患者无显著差异（1.4，p = 0.112）。
气囊扩张术似乎与食管开口改善以及DI和直径的显著变化相关，这与埃卡德特评分的改善一致。扩张术后的DI、直径、食管开口模式和埃卡德特评分未显示出表明需要重复扩张的趋势。
