Farooq Aimen, Bani Fawwaz BahaAldeen, Zhang YiYang, Hasan Muhammad K, Mian Arooj, Khan Hafiz, Brar Tony S, Singh Sanmeet, Viana Artur, Hayat Maham, Xiao Yasi, Aljohani Waleed, Abbasi Abdullah, Chandan Saurabh, Pathak Sagar, Kadkhodayan Kambiz, Arain Mustafa A, Cosgrove Natalie, Jain Deepanshu, Inayat Irteza, Yang Dennis
Gastroenterology, AdventHealth Medical Group, Orlando, United States.
Center for Collaborative Research, AdventHealth Research Institute, Orlando, United States.
Endoscopy. 2025 Jul 30. doi: 10.1055/a-2619-4638.
The functional luminal imaging probe (FLIP) assesses pyloric sphincter physiology. We prospectively used FLIP to evaluate the association between pyloric measurements and clinical outcomes of gastric peroral endoscopic myotomy (G-POEM) in patients with refractory gastroparesis.This was a single-center prospective trial of patients who underwent G-POEM between January 2022 and March 2024. FLIP was performed before G-POEM, immediately after G-POEM, and at follow-up (median 6 months). Clinical response was defined as an improvement of ≥1 point on the Gastroparesis Cardinal Symptom Index (GCSI). A receiver operating characteristic curve was constructed to evaluate the relationship between FLIP measurements and response to G-POEM.Clinical response was achieved in 64/90 patients (71.1%) at a median of 6 months. Mean (SD) FLIP distensibility index (DI) before G-POEM was significantly lower among responders vs. non-responders (7.10 [2.75] vs. 9.24 [3.14] mm2/mmHg; P = 0.002). Mean DI increased significantly in both groups immediately after G-POEM, but this remained elevated only among responders (10.4 [4.4] mm2/mmHg; P < 0.001), returning toward baseline among non-responders (9.7 [4.7] mm2/mmHg; P = 0.69) at 6 months' follow-up. A DI threshold of 7.35 mm2/mmHg before G-POEM had an area under the curve of 0.72 and yielded a specificity of 80.8% and sensitivity of 60.6%.Sustained improvement in pyloric FLIP measurements was seen in patients with a clinical response to G-POEM. Patients who responded to G-POEM had a lower baseline DI compared with non-responders. Additional studies optimizing and standardizing FLIP protocols in patients undergoing G-POEM are needed.
功能性管腔成像探头（FLIP）可评估幽门括约肌的生理功能。我们前瞻性地使用FLIP来评估难治性胃轻瘫患者的幽门测量值与经口内镜下胃肌切开术（G-POEM）临床结局之间的关联。
这是一项单中心前瞻性试验，研究对象为2022年1月至2024年3月期间接受G-POEM的患者。在G-POEM前、G-POEM后即刻以及随访时（中位时间为6个月）进行FLIP检查。临床反应定义为胃轻瘫主要症状指数（GCSI）改善≥1分。构建受试者工作特征曲线以评估FLIP测量值与G-POEM反应之间的关系。
64/90例患者（71.1%）在中位时间6个月时实现了临床反应。G-POEM前，反应者的平均（标准差）FLIP扩张性指数（DI）显著低于无反应者（7.10 [2.75] vs. 9.24 [3.14] mm²/mmHg；P = ０.００２）。两组在G-POEM后即刻平均DI均显著增加，但仅反应者的DI在随访6个月时仍保持升高（10.4 [4.4] mm²/mmHg；P < 0.001），无反应者的DI则恢复至基线水平（9.7 [4.7] mm²/mmHg；P = 0.69）。G-POEM前DI阈值为7.35 mm²/mmHg时，曲线下面积为0.72，特异性为80.8%，敏感性为60.6%。
对G-POEM有临床反应的患者幽门FLIP测量值持续改善。与无反应者相比，对G-POEM有反应的患者基线DI较低。需要进一步开展研究，优化并规范接受G-POEM患者的FLIP检查方案。
