高分辨率阻抗测压期间的生物力学评估增强了对不确定性食管胃交界部流出道梗阻的表征。
Biomechanical Assessment During High-Resolution Impedance Manometry Enhances Characterization of Inconclusive Esophagogastric Junction Outflow Obstruction.
文献信息
| PMID | 42844687 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Aidan D Smires |
| 作者单位 | Kenneth C. Griffin Esophageal Center of Northwestern Medicine, Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. |
| 期刊 | Neurogastroenterology and motility |
| SCI 分区 | Q2 |
| IF | 3.8 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 高分辨率测压（HRM）发现的食管胃交界部流出道梗阻（EGJOO）仍是一种临床异质性且不确定的发现。推荐使用功能性管腔成像探头（FLIP）或定时钡餐食管造影（TBE）进行额外的补充检查，以确认具有临床意义的梗阻。我们旨在评估新型四维（4D）HRM指标与HRM上不确定性EGJOO的有症状患者的FLIP和TBE结果之间的关联。
方法： 纳入完成相应FLIP和TBE研究的HRM-EGJOO不确定性成年患者，进行横断面、回顾性研究。分析EGJ开放、EGJ扩张性指数（4D EGJ-DI）和4D最大EGJ直径的主要4D HRM指标，与FLIP和食管造影定义的参考结果进行比较。
结果： 在123例患者中（平均年龄59岁；60%女性），4D EGJ-DI和4D最大EGJ直径在FLIP和TBE结果类别间存在显著差异（所有p < 0.01）。较低的4D EGJ-DI和较低的4D最大EGJ直径与FLIP上EGJ开放减少和食管造影上异常滞留相关。FLIP上EGJ开放正常的患者中，有0例4D最大EGJ直径 < 8.0 mm；FLIP上EGJ开放减少的患者中，有0例4D EGJ-DI > 2.2 mm2/mmHg且4D最大EGJ直径 > 10.2 mm。
结论： 通过将EGJ开放的生物力学评估与常规压力指标相结合，4D HRM为评估食管运动功能提供了补充的生理信息。这些额外信息可能改善对不确定性EGJOO患者的表征。
英文摘要
BACKGROUND: Esophagogastric junction outflow obstruction (EGJOO) identified on high-resolution manometry (HRM) remains a clinically heterogeneous and inconclusive finding. Additional complementary testing with functional lumen imaging probe (FLIP) or timed barium esophagram (TBE) is recommended to confirm clinically relevant obstruction. We aimed to assess the association of novel Four-Dimensional (4D) HRM metrics against FLIP and TBE outcomes among symptomatic patients with inconclusive EGJOO on HRM.
METHODS: Adult patients with inconclusive HRM-EGJOO who completed corresponding FLIP and TBE studies were identified for inclusion in a cross-sectional, retrospective study. Primary 4D HRM metrics of EGJ opening, EGJ distensibility index (4D EGJ-DI), and 4D maximum EGJ diameter were analyzed relative to reference outcomes defined by FLIP and esophagram.
RESULTS: Among 123 patients (mean age 59 years; 60% female), 4D EGJ-DI and 4D maximum EGJ diameter differed significantly across FLIP and TBE outcome categories (all p < 0.01). Lower 4D EGJ-DI and lower 4D maximum EGJ diameter were associated with reduced EGJ opening on FLIP and abnormal retention on esophagram. There were 0 patients with normal EGJ opening on FLIP that had 4D maximum EGJ diameter < 8.0 mm and 0 patients with reduced EGJ opening on FLIP that had a 4D EGJ-DI > 2.2 mm2/mmHg and 4D maximum EGJ diameter > 10.2 mm.
CONCLUSIONS: By integrating biomechanical assessment of EGJ opening with conventional pressure metrics, 4D HRM provides complementary physiologic information for evaluating esophageal motor function. This additional information may improve characterization of patients with inconclusive EGJOO.