Abstract：
BACKGROUND: Previous studies have demonstrated that 50% of patients with normal high-resolution manometry (HRM) findings or ineffective esophageal motility (IEM) may have abnormal functional luminal imaging probe (FLIP) results. However, the specific HRM findings associated with abnormal FLIP results are unknown. Herein, we investigated the relationship between nonspecific manometry findings and abnormal FLIP results.
METHODS: We retrospectively analyzed 684 patients who underwent HRM at a tertiary care center in Seoul, Korea, based on the Chicago Classification version 4.0 protocol.
RESULTS: Among the 684 patients, 398 had normal HRM findings or IEM. Of these 398 patients, eight showed esophageal wall thickening on endoscopic ultrasonography or computed tomography; however, no abnormalities were seen during esophagogastroduodenoscopy. Among these eight patients, seven showed repetitive simultaneous contractions (RSCs) in at least one of the two positions: 61% (±29%) in 10 swallows in the supine position and 51% (±30%) in five swallows in the upright position. Four patients who underwent FLIP had a significantly decreased esophagogastric junction distensibility index (1.0 ± 0.5 m m 2 mmHg - 1 at 60 mL). Two of these patients underwent per-oral endoscopic myotomy (POEM) due to a lack of response to medication. Esophageal muscle biopsy revealed hypertrophic muscle with marginal eosinophil infiltration.
CONCLUSIONS: A subset of patients (2%) with normal HRM findings or IEM and RSCs experienced dysphagia associated with poor distensibility of the thickened esophageal wall. FLIP assessment or combined HRM and impedance protocols may help better define these patients who may respond well to POEM.
METHODS: We retrospectively analyzed 684 patients who underwent HRM at a tertiary care center in Seoul, Korea, based on the Chicago Classification version 4.0 protocol.
RESULTS: Among the 684 patients, 398 had normal HRM findings or IEM. Of these 398 patients, eight showed esophageal wall thickening on endoscopic ultrasonography or computed tomography; however, no abnormalities were seen during esophagogastroduodenoscopy. Among these eight patients, seven showed repetitive simultaneous contractions (RSCs) in at least one of the two positions: 61% (±29%) in 10 swallows in the supine position and 51% (±30%) in five swallows in the upright position. Four patients who underwent FLIP had a significantly decreased esophagogastric junction distensibility index (1.0 ± 0.5 m m 2 mmHg - 1 at 60 mL). Two of these patients underwent per-oral endoscopic myotomy (POEM) due to a lack of response to medication. Esophageal muscle biopsy revealed hypertrophic muscle with marginal eosinophil infiltration.
CONCLUSIONS: A subset of patients (2%) with normal HRM findings or IEM and RSCs experienced dysphagia associated with poor distensibility of the thickened esophageal wall. FLIP assessment or combined HRM and impedance protocols may help better define these patients who may respond well to POEM.
摘要：
背景：先前的研究表明，50％的高分辨率测压（HRM）正常或食管运动（IEM）无效的患者可能具有异常的功能性腔成像探头（FLIP）结果。然而,与异常FLIP结果相关的具体HRM结果未知.在这里，我们调查了非特异性测压结果与异常FLIP结果之间的关系.
方法：我们回顾性分析了在首尔三级护理中心接受人力资源管理的684例患者，韩国,基于芝加哥分类4.0版协议。
结果：在684名患者中，398具有正常的HRM结果或IEM。在这398名患者中，8例超声内镜或计算机断层扫描显示食管壁增厚；然而，食管胃十二指肠镜检查期间未见异常.在这8名患者中,在两个位置中的至少一个位置显示了重复的同时收缩（RSC）：仰卧位的10只吞咽中有61％（±29％），直立位的5只吞咽中有51％（±30％）。4例接受FLIP的患者食管胃结合部扩张指数显著降低(1.0±0.5mm2mmHg-1$$\\mathrm{m}{\\mathrm{m}}^2{\\mathrm{m}\\mathrm{mHg}}^{-1}$$60mL)。由于对药物缺乏反应，其中两名患者接受了经口内镜肌切开术（POEM）。食管肌肉活检显示肥厚肌伴边缘嗜酸性粒细胞浸润。
结论：HRM表现正常或IEM和RSC正常的患者亚组（2%）出现吞咽困难，与食管壁增厚的扩张性差相关。FLIP评估或联合HRM和阻抗协议可能有助于更好地定义这些可能对POEM反应良好的患者。
方法：我们回顾性分析了在首尔三级护理中心接受人力资源管理的684例患者，韩国,基于芝加哥分类4.0版协议。
结果：在684名患者中，398具有正常的HRM结果或IEM。在这398名患者中，8例超声内镜或计算机断层扫描显示食管壁增厚；然而，食管胃十二指肠镜检查期间未见异常.在这8名患者中,在两个位置中的至少一个位置显示了重复的同时收缩（RSC）：仰卧位的10只吞咽中有61％（±29％），直立位的5只吞咽中有51％（±30％）。4例接受FLIP的患者食管胃结合部扩张指数显著降低(1.0±0.5mm2mmHg-1$$\\mathrm{m}{\\mathrm{m}}^2{\\mathrm{m}\\mathrm{mHg}}^{-1}$$60mL)。由于对药物缺乏反应，其中两名患者接受了经口内镜肌切开术（POEM）。食管肌肉活检显示肥厚肌伴边缘嗜酸性粒细胞浸润。
结论：HRM表现正常或IEM和RSC正常的患者亚组（2%）出现吞咽困难，与食管壁增厚的扩张性差相关。FLIP评估或联合HRM和阻抗协议可能有助于更好地定义这些可能对POEM反应良好的患者。
