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High-resolution manometry with additional maneuvers using the Starlet system: normative thresholds and diagnostic yields for relevant esophagogastric junction outflow disorders

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Abstract

Background

Chicago classification version 4.0 suggests additional maneuvers, such as upright testing, multiple rapid swallows (MRS), and the rapid drink challenge (RDC), for high-resolution manometry (HRM) to minimize ambiguity in the diagnosis of esophageal motility disorders. The present study investigated normative thresholds for these new metrics using the Starlet system as well as their diagnostic yields for relevant esophagogastric outflow disorders (EGJOD).

Methods

In study 1, 30 asymptomatic volunteers prospectively performed HRM including MRS and RDC in the supine/upright positions. We calculated normative thresholds for the new metrics, such as upright integrated relaxation pressure (IRP), upright intrabolus pressure (IBP), and IRP during RDC (RDC-IRP). In study 2, we retrospectively analyzed the HRM tracings of 82 patients who underwent HRM in both positions at our hospital to assess the diagnostic yields of HRM metrics.

Results

Based on the results of study 1, we adopted the following normative thresholds: upright IRP < 20 mmHg, upright IBP < 21 mmHg, and RDC-IRP < 16 mmHg. In study 2, 45 patients with dysphagia or chest pain were included in the analysis to identify predictive factors for clinically relevant esophagogastric outflow disorders (true EGJOD). Supine/upright IRP, RDC-IRP, and pan-esophageal pressurization > 20 mmHg during RDC (RDC-PEP) predicted true EGJOD with RDC-PEP with the highest sensitivity of 91.7%.

Conclusions

HRM with additional maneuvers may facilitate the diagnosis of clinically relevant EGJOD.

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Abbreviations

HRM:

High-resolution manometry

EMD:

Esophageal motility disorders

CCv4.0:

Chicago classification version 4.0

RDC:

Rapid drink challenge

NCCP:

Non-cardiac chest pain

GI:

Gastrointestinal

MRS:

Multiple rapid swallows

FSSG:

Frequency scale for the symptoms of GERD

IRP:

Integrated relaxation pressure

DCI:

Distal contractile integral

DL:

Distal latency

IBP:

Intrabolus pressure

LES:

Lower esophageal sphincter

EGJ-CI:

Esophagogastric junction-contractile integral

PEP:

Pan-esophageal pressurization

EGJOO:

Esophagogastric junction outflow obstruction

IEM:

Ineffective esophageal motility

CCv3.0:

Chicago classification version 3.0

EGJOD:

EGJ-outflow disorders

POEM:

Per-oral endoscopic myotomy

TBE:

Timed barium esophagogram

IQR:

Interquartile ranges

HE:

Hypercontractile esophagus

FLIP:

Functional lumen imaging probe

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Acknowledgements

The authors thank Ms. Satoko Nishimura for her administrative assistance.

Funding

The authors received no specific funding for this work.

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Authors and Affiliations

  1. Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan

    Yoshimasa Hoshikawa, Eri Momma, Noriyuki Kawami & Katsuhiko Iwakiri

  2. Oral Prosthetic Engineering, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan

    Masaomi Ikeda

  3. Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan

    Shiko Kuribayashi

Authors
  1. Yoshimasa Hoshikawa
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  2. Eri Momma
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  3. Noriyuki Kawami
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  4. Masaomi Ikeda
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  5. Shiko Kuribayashi
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  6. Katsuhiko Iwakiri
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Contributions

YH, SK, and KI contributed to the study conception and design. Material preparation and data collection were performed by YH, EM, NK. Data analyses were performed by YH and MI. The first draft of the manuscript was written by YH, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yoshimasa Hoshikawa.

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Conflict of interest

The authors declare no conflicts of interest associated with this manuscript.

Ethical standard

The study protocol was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board (B-2021-377). Informed consent was obtained from all participants. The present study was registered in the UMIN clinical trial register system [UMIN000046572].

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Hoshikawa, Y., Momma, E., Kawami, N. et al. High-resolution manometry with additional maneuvers using the Starlet system: normative thresholds and diagnostic yields for relevant esophagogastric junction outflow disorders. Esophagus 20, 150–157 (2023). https://doi.org/10.1007/s10388-022-00956-z

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  • DOI: https://doi.org/10.1007/s10388-022-00956-z

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