Levenfus Ian, Bianca Amanda, Hente Juliane, Petrowski Katja, Hardt Jochen, Pott Marian C, Pohl Daniel
Department of Gastroenterology and Hepatology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
Medical Psychology and Sociology, Johannes Gutenberg University Mainz, Mainz, Germany.
Dig Dis Sci. 2025 Jun 27. doi: 10.1007/s10620-025-09127-3.
Visual or haptic assessments of the pylorus during endoscopy may result in the diagnosis of a pylorospasm. However, subjective assessments may be affected by inter-rater variability, the antro-duodenal motility phase and the distance to scope. We evaluated to what extent the visual impression, the endoscopic resistance to pyloric intubation and gastric contents correlate with objectively determined values using EndoFLIP measurements.
Patients scheduled for FLIP panometry of the upper gastrointestinal tract due to esophageal or epigastric conditions from January 2021 until November 2022 were considered for the study. Inclusion criteria were an EndoFLIP measurement of the pylorus using a standardized protocol for distensibility assessment and documented subjective assessments during upper endoscopy. Statistical analyses including MANOVA and logistic regression were performed for group comparisons and to evaluate significance.
A total of 184 patients (56% female; mean age 49 ± 17.6 years) were included. The subjective assessment modalities of gastric and pyloric dimensions during endoscopy demonstrated high specificity (> 80%) but low sensitivity (< 50%) in detecting pylorospasm. Group comparisons and post hoc tests revealed no consistent significance between different subjective ratings. Logistic regression analysis showed that objectively determined measurements of pyloric dimensions using FLIP panometry were superior to subjective assessments in identifying pyloric dysfunction.
Subjective assessments of the pylorus during endoscopy are not reliable for diagnosing pyloric dysfunction, such as pylorospasm. This highlights the importance of measurements, not estimates, in the evaluation of pyloric function.
在内镜检查过程中，通过视觉或触觉评估幽门可能会导致幽门痉挛的诊断。然而，主观评估可能会受到评估者间差异、胃十二指肠运动阶段以及与内镜距离的影响。我们评估了视觉印象、内镜插入幽门的阻力以及胃内容物与使用EndoFLIP测量的客观确定值之间的关联程度。
纳入2021年1月至2022年11月因食管或上腹部疾病计划进行上消化道FLIP测压的患者进行研究。纳入标准为使用标准化扩张性评估方案对幽门进行EndoFLIP测量，并记录上消化道内镜检查期间的主观评估。进行包括多变量方差分析（MANOVA）和逻辑回归在内的统计分析以进行组间比较并评估显著性。
共纳入184例患者（56%为女性；平均年龄49±17.6岁）。内镜检查期间对胃和幽门尺寸的主观评估方式在检测幽门痉挛方面显示出高特异性（>80%）但低敏感性（<50%）。组间比较和事后检验显示不同主观评分之间无一致的显著性。逻辑回归分析表明，使用FLIP测压法客观确定的幽门尺寸测量在识别幽门功能障碍方面优于主观评估。
内镜检查期间对幽门的主观评估对于诊断幽门功能障碍（如幽门痉挛）不可靠。这突出了在评估幽门功能时进行测量而非估计的重要性。
