High-resolution manometry studies are frequently imperfect but usually still interpretable
Sabine Roman1, Peter J Kahrilas, Lubomyr Boris
1Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611-2951, USA. roman.sabine@gmail.com
Summary
Technically imperfect esophageal pressure topography (EPT) studies are common, often due to insufficient swallows or EGJ passage issues. Despite technical flaws, EPT data can still yield accurate diagnoses, particularly for achalasia.
Area of Science:
- Gastroenterology
- Diagnostic Imaging
- Esophageal Physiology
Background:
- Clinical esophageal manometry, specifically high-resolution esophageal pressure topography (EPT), presents technical challenges.
- Understanding the frequency and reasons for imperfect EPT studies is crucial for improving diagnostic accuracy in tertiary care settings.
Purpose of the Study:
- To determine the prevalence and identify the causes of technically imperfect high-resolution esophageal pressure topography (EPT) studies.
- To assess the diagnostic utility of imperfect EPT studies.
Main Methods:
- A retrospective review of 2000 consecutive clinical EPT studies was conducted.
- Studies were classified as technically imperfect based on criteria including pressure signal acquisition issues, inability to traverse the esophagogastric junction (EGJ), or fewer than 7 evaluable swallows.
- Data from imperfect studies were blindly interpreted and compared to chart review diagnoses.
Main Results:
- 21% (414/2000) of EPT studies were technically imperfect.
- The primary causes were insufficient evaluable swallows (58%) and failure to traverse the EGJ (29%).
- Large hiatal hernia (50%) and achalasia (24%) were the leading causes for EGJ passage failure, while achalasia (33%) was most associated with incomplete swallows. Blinded interpretation correctly diagnosed achalasia in 77% of cases.
Conclusions:
- Technically imperfect EPT studies are frequent in tertiary care centers, with large hiatal hernias and achalasia being common contributors.
- Despite technical limitations, EPT data can be interpretable and aid in diagnosis, especially when combined with other clinical information.
