경구 내시경 근절개술을 시행한 이완불능증 환자에서 식도 기능 내강 영상 프로브(FLIP) 파노메트리의 예측적 가치: 단일 센터 경험

Abstract

Abstract Background/Aims: We evaluated the clinical significance and prognostic power of FLIP (functional luminal imaging probe) panometry in patients with achalasia treated with POEM (peroral endoscopic myotomy), and examined the clinical parameters associated with symptomatic improvement and partial recovery of peristalsis (PRP) following POEM. Methods: We reviewed the electronic medical records of patients with achalasia treated with FLIP panometry and POEM at a tertiary teaching hospital in Seoul, Republic of Korea. Follow-up examination was composed of esophageal manometry and questionnaires on symptoms. We analyzed the FLIP data by interpolating using the cubic spline method in MATLAB. Results: We retrospectively analyzed 33 men and 35 women (mean age: 52 ± 17 y), of whom 14, 39, and 15 patients were diagnosed with achalasia types I, II, and III, respectively. The FLIP panometry diagnoses were reduced esophagogastric junction opening (REO) with a retrograde contractile response (n=43); REO with an absent contractile response (n=5); REO with a normal contractile response (n=11); and a retrograde contractile response (n=9). Overall, the patients showed improvements in Eckardt scores following POEM from 6.48 ± 2.20 to 1.16 ± 1.15 (p<0.01). Post-POEM symptomatic improvement was not significantly associated with any of the clinical parameters, including panometry diagnosis. Conversely, post-POEM PRP was significantly associated with the presence of repetitive antegrade contractions and achalasia subtypes (both p<0.01). Conclusions: FLIP panometry can predict the clinical course following POEM and can complement manometry in the functional evaluation of esophageal motility disorders. Keywords: achalasia, peroral endoscopic myotomy (POEM), EndoFLIP