Association between endoscopic pressure study integrated system (EPSIS) and high-resolution manometry

Abstract

Background and study aims The endoscopic pressure study integrated system (EPSIS), a novel diagnostic tool for gastroesophageal reflux disease (GERD), allows evaluation of the anti-reflux barrier using endoscopy by monitoring the intragastric pressure (IGP) during insufflation. In this study, we evaluated the association between EPSIS results and lower esophageal sphincter (LES) function measured by high-resolution manometry (HRM) to elucidate whether EPSIS can evaluate the LES function.

Patients and methods A retrospective, single-center study of patients with GERD symptoms who underwent endoscopy, pH-impedance monitoring, EPSIS, and HRM was conducted. The primary outcome was basal LES pressure and the secondary outcomes were end-respiratory LES pressure and integrated relaxation pressure (IRP). As EPSIS parameters, the following were measured: 1) pressure difference (mmHg), the difference between maximum and basal IGP; and 2) pressure gradient (mmHg/s), calculated by dividing pressure difference by the insufflating time. Pressure difference < 4.7 mmHg or pressure gradient < 0.07 mmHg/s was defined as an EPSIS GERD pattern.

Results Forty-seven patients (median age: 53 years, 37 female) were analyzed. Pressure difference and pressure gradient significantly correlated with basal LES pressure (ρ = 0.29; P = 0.04 and ρ = 0.29; P = 0.04). Patients with EPSIS GERD pattern showed significantly lower basal LES pressure [13.2 (4.8–26.6) vs 25.3 (10.4–66.7) mmHg, P = 0.002], lower end-respiratory LES pressure [8.5 (1.1–15.9) vs 15.5 (1.9–43.9) mmHg, P = 0.019] and lower IRP [5.9 (1.0–12.0) vs 9.8 (1.3–17.8) mmHg, P = 0.020].

Conclusions This study showed a close association between EPSIS results and LES pressures measured by HRM. This indicates that EPSIS can evaluate the LES function during endoscopy and endorse the role of EPSIS as a diagnostic tool for GERD.

Publikationsverlauf

Eingereicht: 17. Juli 2021

Angenommen nach Revision: 21. Dezember 2021

Artikel online veröffentlicht:
10. Juni 2022

• References

• 1 Vakil N, van Zanten SV, Kahrilas P. et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006; 101: 1900-1920 quiz 1943
• 2 Tack J, Pandolfino JE. Pathophysiology of gastroesophageal reflux disease. Gastroenterology 2018; 154: 277-288
• 3 Schoeman MN, Tippett MD, Akkermans LM. et al. Mechanisms of gastroesophageal reflux in ambulant healthy human subjects. Gastroenterology 1995; 108: 83-91
• 4 Iwakiri K, Kawami N, Sano H. et al. Mechanisms of excessive esophageal acid exposure in patients with reflux esophagitis. Dig Dis Sci 2009; 54: 1686-1692
• 5 Dodds WJ, Dent J, Hogan WJ. et al. Mechanisms of gastroesophageal reflux in patients with reflux esophagitis. N Engl J Med 1982; 307: 1547-1552
• 6 Inoue H, Shimamura Y, Rodriguez de Santiago E. et al. Diagnostic performance of the endoscopic pressure study integrated system (EPSIS): a novel diagnostic tool for gastroesophageal reflux disease. Endoscopy 2019; 51: 759-762
• 7 Shimamura Y, Inoue H, de Santiago ER. et al. Characterization of intragastric pressure waveform in Endoscopic Pressure Study Integrated System: a novel diagnostic device for gastroesophageal reflux disease. Dig Endosc 2021; 33: 780-787
• 8 Iwaya Y, Inoue H, Rodríguez de Santiago E. et al. Endoscopic pressure study integrated system reflects gastroesophageal junction competence in patients with erosive esophagitis and Barrett´s esophagus. Dig Endosc 2020; 32: 1050-1056
• 9 Inoue H, Ito H, Ikeda H. et al. Anti-reflux mucosectomy for gastroesophageal reflux disease in the absence of hiatus hernia: a pilot study. Ann Gastroenterol 2014; 27: 346-351
• 10 Inoue H, Tanabe M, de Santiago ER. et al. Anti-reflux mucosal ablation (ARMA) as a new treatment for gastroesophageal reflux refractory to proton pump inhibitors: a pilot study. Endosc Int Open 2020; 8: E133-E138
• 11 Kahrilas PJ, Bredenoord AJ, Fox M. et al. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil 2015; 27: 160-174
• 12 Hongo M. Minimal changes in reflux esophagitis: red ones and white ones. J Gastroenterol 2006; 41: 95-99
• 13 Hoshihara Y, Hashimoto M. Endoscopic classification of reflux esophagitis. Nihon Rinsho 2000; 58: 1808-1812
• 14 Inoue H, Fujiyoshi Y, Abad MRA. et al. A novel endoscopic assessment of the gastroesophageal junction for the prediction of gastroesophageal reflux disease: a pilot study. Endosc Int Open 2019; 7: E1468-E1473
• 15 Gyawali CP, Kahrilas PJ, Savarino E. et al. Modern diagnosis of GERD: the Lyon Consensus. Gut 2018; 67: 1351-1362
• 16 Jain M, Srinivas M, Bawane P. et al. Basal lower esophageal sphincter pressure in gastroesophageal reflux disease: An ignored metric in high-resolution esophageal manometry. Indian J Gastroenterol 2018; 37: 446-451
• 17 Sloan S, Rademaker AW, Kahrilas PJ. Determinants of gastroesophageal junction incompetence: hiatal hernia, lower esophageal sphincter, or both?. Ann Intern Med 1992; 117: 977-982
• 18 Ahtaridis G, Snape Jr. WJ, Cohen S. Lower esophageal sphincter pressure as an index of gastroesophageal acid reflux. Dig Dis Sci 1981; 26: 993-998
• 19 Trudgill NJ, Sifrim D, Sweis R. et al. British Society of Gastroenterology guidelines for oesophageal manometry and oesophageal reflux monitoring. Gut 2019; 68: 1731-1750
• 20 Wyman JB, Dent J, Heddle R. et al. Control of belching by the lower oesophageal sphincter. Gut 1990; 31: 639-646
• 21 Holloway RH, Kocyan P, Dent J. Provocation of transient lower esophageal sphincter relaxations by meals in patients with symptomatic gastroesophageal reflux. Dig Dis Sci 1991; 36: 1034-1039
• 22 de Leon A, Ahlstrand R, Thörn SE. et al. Effects of propofol on oesophageal sphincters: a study on young and elderly volunteers using high-resolution solid-state manometry. Eur J Anaesthesiol 2011; 28: 273-278
• 23 Nicodème F, Pipa-Muniz M, Khanna K. et al. Quantifying esophagogastric junction contractility with a novel HRM topographic metric, the EGJ-Contractile Integral: normative values and preliminary evaluation in PPI non-responders. Neurogastroenterol Motil 2014; 26: 353-360
• 24 Tolone S, De Bortoli N, Marabotto E. et al. Esophagogastric junction contractility for clinical assessment in patients with GERD: a real added value?. Neurogastroenterol Motil 2015; 27: 1423-1431