Background and Aims

Endoscopic visible light spectroscopy (VLS) enables measurement of mucosal oxygen saturation during upper GI endoscopy and is used in the diagnostic work-up of chronic mesenteric ischemia (CMI). Currently, VLS is performed when the patient has fasted. We aimed to determine whether food challenge improves the diagnostic performance of VLS measurements for the diagnosis of CMI.

Methods

This was a single-center prospective study of healthy controls and consecutive patients suspected of having CMI and referred to a Dutch specialized CMI center for standardized diagnostic CMI work-up. Immediately after conventional fasting, VLS measurements were taken, luminal feeding was administered, and VLS measurements were repeated 45 minutes later. Patients were classified as CMI if a multidisciplinary expert-based consensus diagnosis of CMI was established and successful revascularization therapy resulted in symptom relief. Patients were classified as no-CMI when consensus diagnosis was not reached or when symptom relief did not occur after technically successful treatment.

Results

We included 60 patients with suspected CMI and 16 healthy controls. Duodenal oxygen saturation was significantly higher postprandially compared with the fasting state: healthy controls: median (interquartile range) pre 54% (49%-56%), post 56% (53%-58%), P = .02), no-CMI patients (pre 55% (51%-57%), post 57% (53%-59%), P > .01); CMI patients: pre 51% (48%-53%), post 54% (50%-58%), P = .01. Mucosal oxygen saturation did not significantly increase postprandially in the duodenal bulb or antrum of the stomach. Absolute postprandial oxygen measurements and the absolute or relative difference between preprandial versus postprandial oxygen measurements did not provide additional discriminative ability for the diagnosis of CMI.

Conclusions

Postprandial VLS measurements have no added benefit for the diagnosis of CMI.

中文翻译：

---

腔内进食后通过内窥镜可见光光谱法检测肠系膜缺血

背景和目标

内窥镜可见光光谱法（VLS）可在上GI内窥镜检查期间测量粘膜氧饱和度，并用于诊断慢性肠系膜缺血（CMI）。当前，当患者禁食时执行VLS。我们旨在确定食物挑战是否可以改善VLS测量对CMI诊断的诊断性能。

方法

这是对健康对照和疑似患有CMI的连续患者进行的单中心前瞻性研究，并转交给荷兰专业CMI中心进行标准化CMI诊断检查。常规禁食后立即进行VLS测量，进行腔内进食，并在45分钟后重复进行VLS测量。如果建立了基于多学科专家共识的CMI诊断并且成功的血运重建治疗可缓解症状，则将患者分类为CMI。当未达到共识诊断或在技术上成功治疗后未出现症状缓解时，患者被分类为无CMI。

结果

我们纳入了60名疑似CMI患者和16名健康对照。与禁食状态相比，餐后十二指肠血氧饱和度显着更高：健康对照组：中位（四分位间距）在前54％（49％-56％），在后56％（53％-58％），P  = .02），无-CMI患者（前55％（51％-57％），后57％（53％-59％），P  > .01）; CMI患者：前51％（48％-53％），后54％（50％-58％），P  = 0.01。餐后在十二指肠球或胃窦中的粘膜氧饱和度没有显着增加。绝对的餐后氧气测量以及餐前与餐后氧气测量之间的绝对或相对差值并未为诊断CMI提供额外的判别能力。

结论

餐后VLS测量对CMI的诊断没有额外的好处。