Four-dimensional impedance manometry volume metrics for predicting abnormal bolus retention.

Autor: Pitisuttithum P; Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.; Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA., Goudie E; Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.; Division of Thoracic Surgery, Department of Surgery, Université de Montréal, Montréal, Quebec, Canada., Araujo IK; Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain., Halder S; Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA., Carlson DA; Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA., Pandolfino JE; Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA., Kou W; Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Jazyk: angličtina
Zdroj: Neurogastroenterology and motility [Neurogastroenterol Motil] 2024 Jul; Vol. 36 (7), pp. e14803. Date of Electronic Publication: 2024 Apr 27.
DOI: 10.1111/nmo.14803
Abstrakt: Background: The objective measurement for esophageal bolus volume and bolus clearance could classify abnormal high-resolution manometry (HRM) beyond the current Chicago classification. We aimed to compare the novel four-dimensional impedance manometry (4D HRM) volume metrics with timed barium esophagram (TBE).
Methods: Adults with esophageal symptoms undergoing HRM and TBE were included. A custom-built program for 4D HRM analysis measured esophageal luminal cross-sectional area (CSA) from impedance and subsequently derived esophageal bolus volume and clearance. 4D HRM volume metrics included pre-swallow residual volume, maximal volume, retention volume, and clearance ratio defined as 1.0-retention volume divided by the maximal volume. An abnormal TBE was defined as a column height >5 cm at 1 min or 5 min.
Key Results: A total of 95 patients (normal motility: 33%; ineffective esophageal motility: 12%; absent contractility: 10%; esophagogastric junction outflow obstruction: 30%; type I achalasia: 5%; type II achalasia: 12%) were categorized into normal TBE (58%), abnormal TBE at 1 min (17%), and abnormal TBE at 5 min (25%). The AUROC demonstrated that, among all 4D HRM volume metrics, the clearance ratio had the best performance in predicting abnormal TBE at 5 min (AUROC, 95% confidence interval: 0.89, 0.82-0.96), and exhibited a strong negative correlation with TBE at 5 min (r = -0.65; p < 0.001).
Conclusions & Inferences: Novel 4D HRM volume metrics provide objective measurement of esophageal bolus volume and bolus clearance. The clearance ratio has a strong correlation with TBE and could potentially serve as a substitute for TBE to measure esophageal retention.
(© 2024 The Authors. Neurogastroenterology & Motility published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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