Per oral endoscopic myotomy(POEM)is rapidly emerging as the treatment of choice for achalasia cardia,but its success is marred by problematic reflux.Although symptomatic reflux rates are low and often comparable to th...Per oral endoscopic myotomy(POEM)is rapidly emerging as the treatment of choice for achalasia cardia,but its success is marred by problematic reflux.Although symptomatic reflux rates are low and often comparable to that after laparoscopic Hellers myotomy(LHM),a high incidence of pathologic reflux has been noted after POEM.This poses a dilemma as to what is true reflux,and in determining the indications and optimal endpoints for managing post-POEM reflux.The two pertinent reasons for the difference in reflux rates between LHM and POEM are the variation in length and location of myotomy and the absence of an anti-reflux procedure in POEM.Proton pump inhibitor remains the most sought-after treatment of POEM derived reflux.Nevertheless,modifications in the procedural technique of POEM and the addition of endoscopic fundoplication can probably emerge as a game changer.This article briefly reviews the incidence,causes,controversies,predictive factors,and management strategies related to post-POEM reflux.展开更多
To assess reference values in the literature for esophageal distensibility and cross-sectional area in healthy and diseased subjects measured by the functional lumen imaging probe (FLIP).METHODSSystematic search and r...To assess reference values in the literature for esophageal distensibility and cross-sectional area in healthy and diseased subjects measured by the functional lumen imaging probe (FLIP).METHODSSystematic search and review of articles in Medline and Embase pertaining to the use of FLIP in the esophagus was conducted in accordance with the PRISMA guidelines. Cross-sectional area and distensibility at the esophagogastric junction (EGJ) were abstracted for normal subjects, achalasia, and gastroesophageal reflux disease (GERD) patients, stratified by balloon length and volume of inflation.RESULTSSix achalasia studies (n = 154), 3 GERD (n = 52), and 5 studies including healthy controls (n = 98) were included in the systematic review. Normative data varied widely amongst studies of healthy volunteers. In contrast, studies in achalasia patients uniformly demonstrated low point estimates in distensibility ≤ 1.6 mm<sup>2</sup>/mmHg prior to treatment that increased to ≥ 3.4 mm<sup>2</sup>/mmHg following treatment at 40mL bag volume. In GERD patients, distensibility fell to the range of untreated achalasia (≤ 2.85 mm<sup>2</sup>/mmHg) following fundoplication.CONCLUSIONFLIP may be a useful tool in assessment of treatment efficacy in achalasia. The drastic drop in EGJ distensibility after fundoplication suggests that FLIP measurements need to be interpreted in the context of esophageal body motility and highlights the importance of pre-operative screening for dysmotility. Future studies using standardized FLIP protocol and balloon size are needed.展开更多
The role of the oesophago-gastric junction (OGJ) in gastro-oesophageal reflux disease is still not completely understood, and there is no clinically used method to assess the OGJ function in patients. Only indirect me...The role of the oesophago-gastric junction (OGJ) in gastro-oesophageal reflux disease is still not completely understood, and there is no clinically used method to assess the OGJ function in patients. Only indirect methods such as pH studies are carried out. The OGJ acts a valve controlling the flow of solids, liquids and gases between the oesophagus and the stomach. Manometry can determine if a sphincter is toned or relaxed; but, it cannot confirm that the sphincter region is actually open. Distension is a new technique for measuring function in the OGJ. By measuring the cross-sectional area through the narrow region in the junction during distension of a catheter mounted bag, much more information on the opening and closing patterns of the junction can be determined. This technique has already been demonstrated to show changes in the OGJ after surgical treatments for reflux disease. New measurement ideas around the concept of distending the OGJ offer new hope that a clinically useable test for compliance at the junction can be developed and could potentially help in determining appropriate therapy.展开更多
文摘Per oral endoscopic myotomy(POEM)is rapidly emerging as the treatment of choice for achalasia cardia,but its success is marred by problematic reflux.Although symptomatic reflux rates are low and often comparable to that after laparoscopic Hellers myotomy(LHM),a high incidence of pathologic reflux has been noted after POEM.This poses a dilemma as to what is true reflux,and in determining the indications and optimal endpoints for managing post-POEM reflux.The two pertinent reasons for the difference in reflux rates between LHM and POEM are the variation in length and location of myotomy and the absence of an anti-reflux procedure in POEM.Proton pump inhibitor remains the most sought-after treatment of POEM derived reflux.Nevertheless,modifications in the procedural technique of POEM and the addition of endoscopic fundoplication can probably emerge as a game changer.This article briefly reviews the incidence,causes,controversies,predictive factors,and management strategies related to post-POEM reflux.
文摘To assess reference values in the literature for esophageal distensibility and cross-sectional area in healthy and diseased subjects measured by the functional lumen imaging probe (FLIP).METHODSSystematic search and review of articles in Medline and Embase pertaining to the use of FLIP in the esophagus was conducted in accordance with the PRISMA guidelines. Cross-sectional area and distensibility at the esophagogastric junction (EGJ) were abstracted for normal subjects, achalasia, and gastroesophageal reflux disease (GERD) patients, stratified by balloon length and volume of inflation.RESULTSSix achalasia studies (n = 154), 3 GERD (n = 52), and 5 studies including healthy controls (n = 98) were included in the systematic review. Normative data varied widely amongst studies of healthy volunteers. In contrast, studies in achalasia patients uniformly demonstrated low point estimates in distensibility ≤ 1.6 mm<sup>2</sup>/mmHg prior to treatment that increased to ≥ 3.4 mm<sup>2</sup>/mmHg following treatment at 40mL bag volume. In GERD patients, distensibility fell to the range of untreated achalasia (≤ 2.85 mm<sup>2</sup>/mmHg) following fundoplication.CONCLUSIONFLIP may be a useful tool in assessment of treatment efficacy in achalasia. The drastic drop in EGJ distensibility after fundoplication suggests that FLIP measurements need to be interpreted in the context of esophageal body motility and highlights the importance of pre-operative screening for dysmotility. Future studies using standardized FLIP protocol and balloon size are needed.
文摘The role of the oesophago-gastric junction (OGJ) in gastro-oesophageal reflux disease is still not completely understood, and there is no clinically used method to assess the OGJ function in patients. Only indirect methods such as pH studies are carried out. The OGJ acts a valve controlling the flow of solids, liquids and gases between the oesophagus and the stomach. Manometry can determine if a sphincter is toned or relaxed; but, it cannot confirm that the sphincter region is actually open. Distension is a new technique for measuring function in the OGJ. By measuring the cross-sectional area through the narrow region in the junction during distension of a catheter mounted bag, much more information on the opening and closing patterns of the junction can be determined. This technique has already been demonstrated to show changes in the OGJ after surgical treatments for reflux disease. New measurement ideas around the concept of distending the OGJ offer new hope that a clinically useable test for compliance at the junction can be developed and could potentially help in determining appropriate therapy.
