Endoscopic pressure study integrated system for the diagnosis of achalasia

Author:

Nishikawa Yohei1,Inoue Haruhiro1,Shimamura Yuto1ORCID,Navarro Marc Julius12,Kawamata Natsuki1,Azuma Daisuke1,Ushikubo Kei1,Kimoto Yoshiaki1ORCID,Yamamoto Kazuki1ORCID,Fujiyoshi Yusuke1ORCID,Okada Hiroki1,Tanaka Ippei1ORCID,Toshimori Akiko1ORCID,Tanabe Mayo1ORCID,Onimaru Manabu1

Affiliation:

1. Digestive Diseases Center Showa University Koto Toyosu Hospital Tokyo Japan

2. Institute of Digestive and Liver Diseases St. Luke's Medical Center Quezon City Philippines

Abstract

ObjectivesThe endoscopic pressure study integrated system (EPSIS) is a novel diagnostic tool used to evaluate lower esophageal sphincter (LES) function. EPSIS allows the measurement of intragastric pressure (IGP) during gastric insufflation through esophagogastroduodenoscopy (EGD) and records its pressure waveform. This study aimed to assess the usefulness and applicability of EPSIS as an adjunct diagnostic modality for achalasia.MethodsThis case–control study was conducted using a database of patients who underwent EGD, barium swallow (BS), high‐resolution manometry (HRM), and EPSIS between January 2022 and December 2022. The achalasia (experimental) group (n = 35) consisted of patients with a definitive diagnosis of achalasia. The control group (n = 34) consisted of patients with no abnormalities in EGD, BS, or HRM and no abnormal acid reflux confirmed with 24‐h pH‐impedance monitoring. EPSIS findings were compared between the two groups and characterized by the waveform pattern (uphill or flat), maximum IGP (IGP‐Max), pressure difference, and the gradient of the waveform.ResultsAll patients in the achalasia group showed an uphill pattern, in contrast to 21 patients (61.8%) in the control group. IGP‐Max demonstrated the best diagnostic accuracy for achalasia, with a cut‐off value of 15.8 mmHg (100% sensitivity, 58.8% specificity, and area under the curve [AUC] 0.78). The pressure gradient also demonstrated good diagnostic accuracy, with a cut‐off value of 0.40 mmHg/s (80% sensitivity, 61.8% specificity, and AUC 0.76).ConclusionThis study demonstrated that EPSIS can be applied as a diagnostic modality in patients with achalasia.

Publisher

Wiley

Subject

Gastroenterology,Radiology, Nuclear Medicine and imaging

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