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首页> 外文期刊>Surgical Endoscopy >Intraoperative assessment of esophagogastric junction distensibility during per oral endoscopic myotomy (POEM) for esophageal motility disorders
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Intraoperative assessment of esophagogastric junction distensibility during per oral endoscopic myotomy (POEM) for esophageal motility disorders

机译：术中评估经口内镜下肌切开术（POEM）食管胃动力障碍

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Background: Per oral endoscopic myotomy (POEM) is a novel treatment for esophageal motility disorders such as achalasia. To date, the extent of the myotomy has been determined based on the subjective assessment of the endoscopist. We hypothesized that the real-time measurement of esophagogastric junction (EGJ) distensibility using a novel functional lumen-imaging probe would enable objective evaluation of POEM. Methods: Patients diagnosed with achalasia disorders electively underwent POEM. Using impedance planimetry with a transorally inserted functional lumen-imaging probe (EndoFLIP?), cross-sectional areas (CSA) and distensibilities at the EGJ were measured intraoperatively immediately before and after the transoral myotomy (n = 4). All patients completed their 6-month follow-up and two patients had repeat distensibility tests at this time. Four healthy volunteers served as a control group. Results: POEM was successfully performed in all patients (4/4). Premyotomy measurements (40-ml fill mode) showed a median diameter of 6.5 mm (range = 5.2-7.9 mm) at the narrowest location of the EGJ and was 10.1 mm (7.3-13.2 mm) following POEM. CSA increased from 41.5 mm2 (20-49 mm2) to 86 mm2 (41-137 mm2) at a similar median intraballoon pressure (40.3 vs. 38.6 mmHg). The increased EGJ distensibility (DI, 1.0 vs. 2.4 mm2/mmHg) was comparable to that of healthy volunteers (2.7 mm2/mmHg). Conclusion: Functional lumen distensibility measures show that POEM can result in an immediate correction of the nonrelaxing lower esophageal sphincter, which appears similar to that of healthy controls. Intraoperative EGJ profiling may be an important tool to objectively guide the needed extent and completeness of the myotomy during POEM.
机译：背景：经口内镜下肌切开术（POEM）是一种针对食管运动障碍（例如门失弛缓症）的新型治疗方法。迄今为止，已经根据内镜医师的主观评估确定了肌切开术的程度。我们假设使用新型功能性内腔成像探头实时测量食管胃接合部（EGJ）的可扩张性将能够客观评估POEM。方法：选择诊断为失弛缓症的患者进行POEM。使用经口插入的功能性内腔成像探头（EndoFLIP？）进行阻抗平面测量，在术中立即进行经口肌切开术前后（n = 4），测量EGJ的横截面积（CSA）和可扩张性。所有患者均完成了6个月的随访，此时有2位患者进行了重复的扩张性测试。四名健康志愿者作为对照组。结果：所有患者均成功进行了POEM（4/4）。肌切开术前的测量（40 ml填充模式）显示，在EGJ最狭窄的位置，中位直径为6.5 mm（范围= 5.2-7.9 mm），在POEM之后为10.1 mm（7.3-13.2 mm）。在类似的气球内中压（40.3 vs. 38.6 mmHg）下，CSA从41.5 mm2（20-49 mm2）增加到86 mm2（41-137 mm2）。 EGJ扩张性增加（DI，1.0 vs. 2.4 mm2 / mmHg）与健康志愿者（2.7 mm2 / mmHg）相当。结论：功能性管腔扩张性措施表明，POEM可以立即纠正无松弛的食管下括约肌，这看起来与健康对照组相似。术中EGJ轮廓分析可能是重要的工具，可以客观地指导POEM期间所需的肌切开术的程度和完整性。

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