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bile reux, and the Bilitec’s invitro sensitivity to bile acids is more reliable than
invivo.
Accuracy of optical ber spectrophotometry detection is related to environmen-
tal pH and food species. Vaezi etal. [56] found that in pH <3.5, bile shifted from
450nm to 400nm in spectrophotometry, and the measured absorption decreased by
about 30%. The correlation between bile acid concentration and bile acid absorption
was good in pH <3.5. It is suggested that the results may be underestimated in pH
<3.5 environment. The type of food needs to avoid eating foods containing carotene
and other similar light absorption characteristics of cholin, and the properties of
liquid or solid also affect the test results. Tack etal. [57] carried out 24-h dynamic
monitoring of bilirubin in 40 healthy subjects and 211 patients with continuous
assessment of suspected gastroesophageal reux disease; 19% of solid dietary
patients had dietary artifacts and no artifacts were found in liquid diet. Bilitec moni-
toring using liquid food monitoring results are more accurate.
7.5 Multichannel Intracavity Impedance Technique
In 1991, Silny etal. [58] described a new high-resolution measurement of gastroin-
testinal motility, by sequentially arranging catheters with multiple annular elec-
trodes (diameter 2.1mm), collecting the change of electrical impedance in human
esophagus (the degree of obstruction of current between adjacent electrodes), thus
determining the state (gas, liquid, or mixture) of the reux/pass through the esopha-
gus and the range and direction of movement. The simple impedance monitoring in
multichannel tubes does not reect the acid-base properties of the reux. Currently,
the general joint pH serves as a common monitoring tool, termed 24h esophageal
multichannel intracavity impedance-pH monitoring technique (MII-pH).
Impedance is measured by alternating current. Generally speaking, the higher
the impedance, there is less ion ow between the two electrodes. On the contrary,
the lower the impedance, the stronger the uidity of ions. For example, there is only
air between the two electrodes, almost no ion ow, and the impedance is high, about
10,000Ω×cm. The impedance is high. Different substances have different imped-
ance values. In MII-pH testing, the range and direction are judged by measuring the
impedance to determine the properties of the reux/pass object and the setting of
multi-electrode.
One analysis of MII-pH in children with gastroesophageal reux disease showed
that the sensitivity of the assay >70 and the specicity reached 80% [59]. Vardar and
other [60] studies showed that 17–31.4% of patients with endoscopic denite diag-
nosis of esophagitis were negative. Compared with MII-pH monitoring, the sensi-
tivity of pH catheter to detect acid reux was 58%, and the sensitivity to detect weak
acid reux was 28%. One retrospective note indicates that pH-MII has higher accu-
racy when postprandial or gastric contents are non-acidic. Furthermore, pH- MII is
superior to the individually monitored values for assessing the temporal relationship
7 Evaluation ofEndoscopic Treatment forGERD
98
between symptoms and gastroesophageal reux. Savarino and others found that pH-
MII contribution to the identication of reux and functional heartburn increased by
3–10% compared with the measurement or use of proton pump inhibitors alone [61,
62]. The MII-pH measurement principle denes that the data it collects is a collec-
tion of multiple substance results, which cannot reect the results of a single sub-
stance. In addition to the combined pH monitoring acid and weak acid reux, the
combined Bilitec-pH can accurately detect bile reux. Pace etal. [63] monitored 20
patients with gastroesophageal reux disease with bilirubin and IIM-pH values at
the same time. The results showed that bile reux and non-acid reux were detected
by Bilitec and IIM, respectively. The two are two different phenomena and need
different techniques to evaluate.
7.6 Endoscopic Functional Lumen Imaging Probes
Endoscopic functional channel imaging probe (endoluminal functional lumen imag-
ing probe, EndoFLIP) is a new technique for measuring the sphincter tension of
cavity organs. The main principle is to put a bag containing 16 measuring electrodes
into a cavity wrapped in sphincter to be measured. The bag can be injected into
0–50ml liquid containing conductive properties through syringe. It can measure
cross-sectional area and corresponding pressure [64]. Compared to the traditional
pressure measurement technology, it can display real-time pressure information in
the form of a histogram through a connected computer screen. The histogram con-
sists of 16 circles, corresponding to 16 electrodes, and the results are directly dis-
played by different colors (the highest red pressure and the lowest blue pressure),
respectively. This technique has achieved a clear and benecial effect in the diagno-
sis and treatment of cardia retardation and gastroesophageal reux disease.
Kwiatek etal. [64] studied the pressure data of gastroesophageal junction (EGJ)
by EndoFLIP technique in 20 patients and 20 controls. GERD patients showed EGJ
dilation 2–3 times more than the control group, especially at 20–30ml expansion
volume, which showed GERD patient EGJ area is more relaxed. For patients with
cardiac retardation, EGJ pressure is higher than that of normal people. This tech-
nique has a huge effect in surgical and endoscopic treatment of patients with GERD
or cardia loss. We know that prior therapies, whether they increased or decreased
stress in EGJ, lacked a real-time assessment of their effectiveness or excessiveness.
However, EndoFLIP technology has changed this paradigm. Yeung et al. [65]
treated with practice of enterprise modelling (POEM) in children with achalasia.
The EndoFLIP real-time monitoring of pressure index increased from 1.7mm
2
/
mmHg before operation to 6.0 after operation. High-resolution esophageal manom-
etry 7months after operation showed normal lower esophageal sphincter pressure
and resting tension after treatment. Ilczyszyn etal. [66] found in the treatment of
GERD by laparoscopic Nissen gastric base-folding surgery that the tension index of
one patient after treatment was 0.47mm
2
/mmHg, which was the lowest in their
X. Huang
99
post-treatment data. Later, this patient had obvious symptoms of dysphagia and
needed reoperation. In the other 12 patients, 360° wrapping was used, which was
changed to 270° wrapping when the intraoperative folding felt too tight, and the
tension index was changed from 0.65 to 0.89 mm
2
/mmHg, which avoided the
patients’ second operation and demonstrated the value of EndoFLIP technology in
guiding the intraoperative modication. EndoFLIP technique is not only used in
esophagus. Malik etal. [67] studied the correlation between pyloric dysfunction and
gastroparesis and showed that there was a negative correlation between the symp-
toms of early satiety and postprandial satiety. The application prospect of this tech-
nology is very broad.
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