The new value of gastroscopy in the diagnosis of esophageal hiatal hernia
Objective To analyze the new value of gastroscopy in the diagnosis of esophageal hiatal hernia(EHH).Methods From March 7 to September 24 in 2019,194 patients with gastroesophageal reflux disease who received endoscopy and high resolution esophageal manometry(HREM)at the Department of Gastroesophageal Surgery,the PLA Rocket Force Medical Center were selected.The transverse diameter of esophageal hiatus and the upward length of esophagogastric junction(EGJ)were measured under endoscopy,and the relevant data of reflux esophagitis(RE)and length and pressure of lower esophageal sphincter(LES)were collected.The value of traditional method under endoscopy and esophageal hiatus transverse diameter(EHTD)method under endoscopy in the diagnosis of EHH was compared.Independent sample-t test,rank sum test and chi-square test were used for statistical analysis.Results The detection rate of EHH by EHTD method under endescopy was higher than that by traditional method under endoscopy and HREM method(60.8％,118/194 vs.14.9％,29/194 and 37.1％,72/194),and the detection rate of EHH by HREM method was higher than that by traditional method under endoscopy,and the differences were statistically significant(x2=86.75,21.82,and 24.75;all P＜0.001).The proportion of RE,the upward length of EGJ and the transverse diameter of esophageal hiatus of EHH patients diagnosed by traditional method under endoscopy and EHTD method under endoscopy were all higher than those of non-EHH patients(79.3％,23/29 vs.28.5％,47/165;49.2％,58/118 vs.15.8％,12/76;2.0(2.0,3.0)cm vs.0.4(0,0.7)cm,0.7(0,1.6)cmvs.0(0,0.6)cm;(2.60±0.71)cm vs.(1.88±0.44)cm,(2.30±0.45)cmvs.(1.51±0.29)cm);the minimum resting pressure of LES and resting pressure of LES were both lower than those of non-EHH patients(3.7(0.3,12.1)mmHg(1 mmHg=0.133 kPa)vs.9.1(3.3,14.2)mmHg,6.4(2.2,12.5)mmHg vs.10.8(4.7,15.5)mmHg;(9.70±7.92)mmHg vs.(14.92±10.30)mmHg,(11.36±7.79)mmHg vs.(18.44±11.78)mmHg);the length of intraperitoneal LES were shorter than that of non-EHH patients(0(0,1.4)cm vs.1.1(0,1.7)cm,0.3(0,1.5)cm vs.1.3(0.4,1.8)cm);the length of LES of EHH patients diagnosed by EHTD method under endoscopy was shorter than that of non-EHH patients((2.83±0.63)cm vs.(3.10±0.66)cm),and the differences were statistically significant(X2=26.53 and 22.31,Z=-8.26 and-5.04,t=5.26 and 13.67,Z=-2.14 and-2.71,t=-2.59 and-4.63,Z=-2.58 and-3.60,t=-2.96;all P＜0.05).There were no significant differences in gender,LES length,intraperitoneal LES length,minimum resting pressure of LES,resting pressure of LES and residual pressure of LES between EHH patients diagnosed by EHTD method and traditional method under endoscopy(all P＞0.05).Conclusions Endoscopy plays a significant role in the diagnosis of EHH.EHTD method under endoscopy is more accurate in the diagnosis of sliding EHH,which is worthy of clinical reference.
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