Novel 3D high-resolution manometry metrics for quantifying esophagogastric junction contractility

Area of Science:

• Gastroenterology
• Physiology
• Medical Imaging

Background:

• The esophagogastric junction (EGJ) is a complex sphincter involving the crural diaphragm (CD) and lower esophageal sphincter (LES).
• Three-dimensional high-resolution manometry (3D-HRM) offers a detailed 360° view of EGJ pressure dynamics, with the CD exhibiting a unique pressure signature.

Purpose of the Study:

• To develop novel 3D-HRM metrics for quantifying CD contractility (3D-DH_A).
• To devise 3D-HRM metrics to isolate the LES component of EGJ contractility (3D-LESP).
• To compare these new metrics against conventional HRM measures of EGJ contractility.

Main Methods:

• Twenty healthy subjects underwent 3D-HRM studies.
• Two new metrics, 3D-DH_A and 3D-LESP, were calculated to represent CD and LES contributions to EGJ pressure.
• These were compared with conventional metrics: EGJ-CI, inspiratory EGJ pressure, and expiratory EGJ pressure.

Main Results:

• Mean 3D-DH_A showed a strong correlation with EGJ-CI (r=.82, P<.001).
• 3D-LESP demonstrated the strongest correlation with inspiratory EGJ pressure (r=.91, P<.001) and expiratory EGJ pressure (r=.85, P<.001).

Conclusions:

• Novel 3D-HRM metrics, 3D-DH_A and 3D-LESP, were successfully developed to quantify CD and LES contractility, respectively.
• Both new metrics correlate strongly with established conventional HRM measures.
• 3D-DH_A's strong correlation with EGJ-CI suggests it primarily reflects CD contractility, potentially aiding in GERD mechanistic subtyping.