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삼킴곤란의 진단: 고해상도 내압 검사 및 엔도플립

Diagnosis of Dysphagia: High Resolution Manometry & EndoFLIP

대한소화기학회지 2021년 77권 2호 p.64 ~ 70
차보람, 정기욱,
소속 상세정보
차보람 ( Cha Bo-Ram ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
정기욱 ( Jeong Kee-Wook ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology

Abstract


Esophageal motility disorders were re-defined when high-resolution manometry was employed to better understand their pathogenesis. Newly developed parameters including integrated relaxation pressure (IRP), distal contractile integral, and distal latency showed better diagnostic yield compared with previously used conventional parameters. Therefore, Chicago classification was formulated, and its diagnostic cascade begins by assessing the IRP value. However, IRP showed limitation due to its inconsistency, and other studies have tried to overcome this. Recent studies showed that provocative tests, supplementing the conventional esophageal manometry protocol, have improved the diagnostic yield of the esophageal motility disorders. Therefore, position change from supine to upright, solid or semi-solid swallowing, multiple rapid swallows, and the rapid drink challenge were newly added to the manometry protocol in the revised Chicago classification version 4.0. Impedance planimetry enables measurement of bag cross-sectional area at various locations. The functional lumen imaging probe (FLIP) has been applied to assess luminal distensibility. This probe can also measure pressure, serial cross-sectional areas, and tension-strain relationship. The esophagogastric junction’s distensibility is decreased in achalasia. Therefore, EndoFLIP can be used to assess contractility and distensibility of the esophagus in the patients with achalasia, including repetitive antegrade or retrograde contractions. EndoFLIP can detect achalasia patients with relatively low IRP, which was difficult to diagnose using the current high-resolution manometry. EndoFLIP also provides information on the contractile activity and distensibility of the esophageal body in patients with achalasia. The use of provocative tests, newly added in Chicago classification 4.0 version, and EndoFLIP can expand understanding of esophageal motility disorders.

키워드

Esophageal motility disorder; Esophageal achalasia; Manometry; EndoFLIP

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