Abstract：
OBJECTIVE: Esophagogastric junction outflow obstruction (EGJOO), defined manometrically by impaired esophagogastric junction relaxation (EGJ) with preserved peristalsis, can be artifactual, due to secondary etiologies (mechanical, medication-induced), or a true motility disorder. The purpose of this review is to go over the evolving approach to diagnosing and treating clinically relevant EGJOO.
RESULTS: Timed barium esophagram (TBE) and the functional lumen imaging probe (FLIP) are useful to identify clinically relevant EGJOO that merits lower esophageal sphincter (LES) directed therapies. There are no randomized controlled trials evaluating EJGOO treatment. Uncontrolled trials show effectiveness for pneumatic dilation and peroral endoscopic myotomy to treat confirmed EGJOO; Botox and Heller myotomy may also be considered but data for confirmed EGJOO is more limited. Diagnosis of clinically relevant idiopathic EGJOO requires symptoms, exclusion of mechanical and medication-related etiologies, and confirmation of EGJ obstruction by TBE or FLIP. Botox LES injection has limited durability, it can be used in patients who are not candidates for other treatments. PD and POEM are effective in confirmed EGJOO, Heller myotomy may also be considered but data for confirmed EGJOO is limited. Randomized controlled trials are needed to clarify optimal management of EGJOO.
RESULTS: Timed barium esophagram (TBE) and the functional lumen imaging probe (FLIP) are useful to identify clinically relevant EGJOO that merits lower esophageal sphincter (LES) directed therapies. There are no randomized controlled trials evaluating EJGOO treatment. Uncontrolled trials show effectiveness for pneumatic dilation and peroral endoscopic myotomy to treat confirmed EGJOO; Botox and Heller myotomy may also be considered but data for confirmed EGJOO is more limited. Diagnosis of clinically relevant idiopathic EGJOO requires symptoms, exclusion of mechanical and medication-related etiologies, and confirmation of EGJ obstruction by TBE or FLIP. Botox LES injection has limited durability, it can be used in patients who are not candidates for other treatments. PD and POEM are effective in confirmed EGJOO, Heller myotomy may also be considered but data for confirmed EGJOO is limited. Randomized controlled trials are needed to clarify optimal management of EGJOO.
摘要：
目的：食管胃结合部流出道梗阻（EGJOO），通过保留蠕动的食管胃交界处松弛（EGJ）受损，可以是人为的，由于继发性病因(机械性，药物诱导)，或者真正的运动障碍。这篇综述的目的是回顾不断发展的诊断和治疗临床相关EGJOO的方法。
结果：定时钡食管造影（TBE）和功能性管腔成像探头（FLIP）可用于确定值得下食管括约肌（LES）定向治疗的临床相关EGJOO。目前尚无评估EJGOO治疗的随机对照试验。非对照试验显示，气动扩张术和经口内镜下肌切开术治疗确诊EGJOO的有效性；也可以考虑肉毒杆菌毒素和海勒肌切开术，但确诊EGJOO的数据更有限。临床相关特发性EGJOO的诊断需要症状，排除机械和药物相关病因，并通过TBE或FLIP确认EGJ阻塞。BotoxLES注射具有有限的耐用性，它可以用于不适合其他治疗的患者。PD和POEM在确认的EGJOO中有效，也可以考虑进行Heller肌切开术，但确认EGJOO的数据有限。需要随机对照试验来阐明EGJOO的最佳管理。
结果：定时钡食管造影（TBE）和功能性管腔成像探头（FLIP）可用于确定值得下食管括约肌（LES）定向治疗的临床相关EGJOO。目前尚无评估EJGOO治疗的随机对照试验。非对照试验显示，气动扩张术和经口内镜下肌切开术治疗确诊EGJOO的有效性；也可以考虑肉毒杆菌毒素和海勒肌切开术，但确诊EGJOO的数据更有限。临床相关特发性EGJOO的诊断需要症状，排除机械和药物相关病因，并通过TBE或FLIP确认EGJ阻塞。BotoxLES注射具有有限的耐用性，它可以用于不适合其他治疗的患者。PD和POEM在确认的EGJOO中有效，也可以考虑进行Heller肌切开术，但确认EGJOO的数据有限。需要随机对照试验来阐明EGJOO的最佳管理。
