INTRODUCTION Four-dimensional high-resolution impedance manometry (4D HRM) uses impedance to estimate esophageal luminal cross-sectional area and track nadir impedance to measure intrabolus pressure (IBP). We aimed to determine whether 4D HRM metrics could define abnormal esophagogastric junction (EGJ) opening between Chicago Classification version 4.0 motility disorders and compare 4D HRM with functional lumen imaging probe (FLIP) metrics. METHODS Symptomatic adult patients who completed high-resolution impedance manometry and FLIP were included and compared with an asymptomatic control group. 4D HRM analysis used custom-built software to measure IBP, maximum EGJ diameter, and distensibility index on supine test swallows. 4D HRM metrics were compared with FLIP EGJ metrics. RESULTS Ninety patients (31 normal motility, 16 ineffective esophageal manometry, 9 absent contractility, 8 conclusive EGJ outflow obstruction [EGJOO], 12 type I achalasia, 14 type II achalasia, 12 type III achalasia, and 34 asymptomatic controls) were included. Phase 2 and 3 IBP was higher in type II and III achalasia compared with controls and normal motility groups ( P < 0.03). Maximum EGJ diameter and EGJ-distensibility index in the conclusive EGJOO and achalasia groups were significantly lower than in controls and normal motility groups ( P < 0.03). 4D HRM identified 37 of 44 (84%) subjects with normal EGJ opening and 29 of 39 (74%) subjects with reduced EGJ opening on FLIP. DISCUSSION 4D HRM metrics correlated with expected clinical observations across a spectrum of esophageal motility disorders and defined EGJ obstruction. 4D HRM metrics may have value in defining EGJ obstruction in equivocal cases related to EGJOO or absent peristalsis.

中文翻译：

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食管动力障碍中的四维阻抗测压。


引言 四维高分辨率阻抗测压 （4D HRM） 使用阻抗来估计食管腔横截面积并跟踪最低阻抗来测量推注内压 （IBP）。我们旨在确定 4D HRM 指标是否可以定义芝加哥分类 4.0 版运动障碍之间的异常食管胃交界处 （EGJ） 开放，并将 4D HRM 与功能性管腔成像探针 （FLIP） 指标进行比较。方法 纳入完成高分辨率阻抗测压和 FLIP 的有症状成年患者，并与无症状对照组进行比较。4D HRM 分析使用定制软件来测量仰卧测试燕子的 IBP、最大 EGJ 直径和扩张指数。将 4D HRM 指标与 FLIP EGJ 指标进行比较。结果 共纳入 90 例患者 （31 例运动正常，16 例食管测压无效，9 例无收缩力，8 例确凿 EGJ 流出道梗阻 [EGJOO]，12 例 I 型贲门失弛缓症，14 例 II 型贲门失弛缓症，12 例 III 型贲门失弛缓症，34 例无症状对照。与对照组和正常运动组相比，II 型和 III 型贲门失弛缓症的 2 期和 3 期 IBP 较高 （ P < 0.03）。结论性 EGJOO 组和贲门失弛缓症组的最大 EGJ 直径和 EGJ 扩张指数显著低于对照组和正常运动组 （P < 0.03）。4D HRM 确定了 44 名受试者中的 37 名 （84%） EGJ 开度正常，39 名受试者中的 29 名 （74%） 在 FLIP 上 EGJ 开度降低。讨论 4D HRM 指标与一系列食管动力障碍的预期临床观察相关，并确定 EGJ 梗阻。4D HRM 指标可能在定义与 EGJOO 相关或蠕动缺失的模棱两可的病例中具有 EGJ 梗阻的价值。