Eriksson Sven E, Sarici Inanc S, Nguyen Johnathan, Fryer Mara, Zheng Ping, Ayazi Shahin
Foregut Division, Surgical Institute, Allegheny Health Network, Pittsburgh, PA, United States; Chevalier Jackson Esophageal Research Center, Western Pennsylvania Hospital, Pittsburgh, PA, United States.
Foregut Division, Surgical Institute, Allegheny Health Network, Pittsburgh, PA, United States.
J Gastrointest Surg. 2025 Aug;29(8):102097. doi: 10.1016/j.gassur.2025.102097. Epub 2025 Jun 18.
Mucosal impedance (MI) is a novel diagnostic tool that quantifies esophageal mucosal integrity by measuring tissue conductivity. Previous studies have demonstrated that healthy individuals exhibit high, stable MI values throughout the esophagus and that those with gastroesophageal reflux disease (GERD) exhibit low distal MI values and a steep axial gradient. The role of MI in the postoperative setting has not been evaluated, and it is unknown whether antireflux surgery (ARS) restores mucosal integrity to normal levels. This study aimed to determine whether MI differentiates between intact and failed Nissen fundoplication and objectively assesses reflux barrier function after ARS.
Patients who underwent Nissen fundoplication and had either intact or failed (slipped, disrupted, or herniated) fundoplication on endoscopy at ≥1 year were offered MI testing. In addition, a non-GERD control group (n = 10) with no previous foregut surgery and normal endoscopy and pH monitoring underwent MI testing. MI was measured at 1-cm intervals along the distal esophagus. Axial MI patterns were compared between the groups.
The study included 25 post fundoplication patients (60% female, mean age of 61.3 ± 13.7 years, and mean body mass index of 28.2 ± 4.7 kg/m), 11 with intact fundoplication and 14 with anatomical failure. Patients with intact fundoplication had significantly higher MI values at 1 (P =.0326), 2 (P =.005), 3 (P <.05), and 5 (P =.018) cm above the squamocolumnar junction (SCJ). All MI values and patterns in patients with intact fundoplication were comparable with those of non-GERD controls (P >.05). Patients with failed fundoplication had a steeper axial MI gradient than those with intact fundoplication (251 vs 23 Ω/cm, respectively; P <.05). In addition, the distal MI value was significantly lower in patients with failed fundoplication than in those with intact fundoplication (2706 vs 4921 Ω, respectively; P <.05).
MI demonstrates that an intact Nissen fundoplication restores mucosal integrity to levels comparable to those of individuals without GERD. Failed fundoplications exhibit persistent GERD-like MI patterns. Therefore, MI provides an objective physiologic marker of surgical success and may aid in postoperative management.
黏膜阻抗（MI）是一种通过测量组织电导率来量化食管黏膜完整性的新型诊断工具。先前的研究表明，健康个体在整个食管中表现出高且稳定的MI值，而患有胃食管反流病（GERD）的个体则表现出较低的远端MI值和陡峭的轴向梯度。MI在术后环境中的作用尚未得到评估，抗反流手术（ARS）是否能将黏膜完整性恢复到正常水平也尚不清楚。本研究旨在确定MI是否能区分尼氏胃底折叠术成功与失败，并客观评估ARS后的反流屏障功能。
对接受尼氏胃底折叠术且在内镜检查中≥1年时胃底折叠术完整或失败（滑脱、破裂或疝出）的患者进行MI检测。此外，对一组无前肠手术史、内镜检查和pH监测正常的非GERD对照组（n = 10）进行MI检测。沿食管远端每隔1 cm测量MI。比较各组之间的轴向MI模式。
该研究纳入了25例胃底折叠术后患者（60%为女性，平均年龄61.3±13.7岁，平均体重指数28.2±4.7 kg/m²），其中11例胃底折叠术完整，14例存在解剖学失败。胃底折叠术完整的患者在鳞柱状上皮交界处（SCJ）上方1 cm（P = 0.0326）、2 cm（P = 0.005）、3 cm（P < 0.05）和5 cm（P = 0.018）处的MI值显著更高。胃底折叠术完整的患者的所有MI值和模式与非GERD对照组相当（P > 0.05）。胃底折叠术失败的患者的轴向MI梯度比胃底折叠术完整的患者更陡峭（分别为251和23 Ω/cm；P < 0.05）。此外，胃底折叠术失败的患者的远端MI值显著低于胃底折叠术完整的患者（分别为2706和4921 Ω；P < 0.05）。
MI表明完整的尼氏胃底折叠术可将黏膜完整性恢复到与无GERD个体相当的水平。失败的胃底折叠术表现出持续的类似GERD的MI模式。因此，MI提供了手术成功的客观生理标志物，并可能有助于术后管理。
