Esophageal distensibility measurement: impact on clinical management and procedure length.

Autor: Ahuja NK; Division of Gastroenterology and Hepatology., Agnihotri A; Department of Internal Medicine, Johns Hopkins Bayview Medical Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Lynch KL; Division of Gastroenterology and Hepatology., Hoo-Fatt D; Department of Internal Medicine, Johns Hopkins Bayview Medical Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Onyimba F; Division of Gastroenterology and Hepatology., McKnight M; Division of Gastroenterology and Hepatology., Okeke FC; Department of Internal Medicine, Johns Hopkins Bayview Medical Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Garcia P; Division of Gastroenterology and Hepatology., Dhalla S; Division of Gastroenterology and Hepatology., Stein E; Division of Gastroenterology and Hepatology., Pasricha PJ; Division of Gastroenterology and Hepatology., Clarke JO; Division of Gastroenterology and Hepatology.
Jazyk: angličtina
Zdroj: Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus [Dis Esophagus] 2017 Aug 01; Vol. 30 (8), pp. 1-8.
DOI: 10.1093/dote/dox038
Abstrakt: Luminal distensibility measurement has demonstrated relevance to various disease processes, though its effects on clinical decision-making have been less well understood. This study aims to characterize the clinical impact of impedance planimetry measurement as well as the learning curve associated with its use in the esophagus. A single provider performed distensibility measurement in conjunction with upper endoscopy for a variety of clinical indications with the functional lumen imaging probe (FLIP) over a period of 21 months. Procedural data were prospectively collected and, along with medical records, retrospectively reviewed. Seventy-three procedures (70 patients) underwent esophageal distensibility measurement over the timeline of this study. The most common procedural indications were known or suspected achalasia (32.9%), dysphagia with connective tissue disease (13.7%), eosinophilic esophagitis (12.3%), and dysphagia with prior fundoplication (9.6%). FLIP results independently led to a change in management in 29 (39.7%) cases and supported a change in management in an additional 15 (20.5%) cases. The most common change in management was a new or amended therapeutic procedure (79.5%). Procedural time added by distensibility measurement was greater among earlier cases than among later cases. The median time added overall was 5 minutes and 46 seconds. Procedural time added varied significantly by procedural indication, but changes in management did not. Distensibility measurement added meaningful diagnostic information that impacted therapeutic decision-making in the majority of cases in which it was performed. Procedural time added by this modality is typically modest and decreases with experience.
(© The Authors 2017. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze: MEDLINE
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