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Optimal cutoff value of integrated relaxation pressure on the esophagogastric junction to detect outflow obstruction using starlet high-resolution manometry system

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Abstract

Background

Achalasia and esophagogastric junction outflow obstruction (EGJOO) are idiopathic esophageal motility disorders characterized by impaired deglutitive relaxation of the lower esophageal sphincter (LES). High-resolution manometry (HRM) provides integrated relaxation pressure (IRP) which represents adequacy of LES relaxation. The Starlet HRM system is widely used in Japan; however, IRP values in achalasia/EGJOO patients assessed with the Starlet system have not been well studied. We propose the optimal cutoff of IRP for detecting achalasia/EGJOO using the Starlet system.

Methods

Patients undergone HRM test using the Starlet system at our institution between July 2018 and September 2020 were included. Of these, we included patients with either achalasia or EGJOO and those who had normal esophageal motility without hiatal hernia. Abnormally impaired LES relaxation (i.e., achalasia and EGJOO) was diagnosed if prolonged esophageal emptying was evident based on timed barium esophagogram (TBE).

Results

A total of 111 patients met study criteria. Of these, 48 patients were diagnosed with achalasia (n = 45 [type I, n = 20; type II, n = 22; type III, n = 3]) or EGJOO (n = 3). In the 48 patients who had a prolonged esophageal clearance based on TBE, IRP values distributed along a wide-range of minimal 14.1 to a maximal of 72.2 mmHg. The optimal cutoff value of IRP was 24.7 mmHg with sensitivity of 89.6% and specificity of 84.1% (AUC 0.94).

Conclusion

The optimal cutoff value of IRP to distinguish achalasia/EGJOO was ≥ 25 mmHg using the Starlet HRM system in our cohort. This indicates that the current proposed cutoff of 26 mmHg appears to be relevant.

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Abbreviations

AUC:

Area under the ROC curve

CT:

Computed tomography

EGD:

Esophagogastroduodenoscopy

EGJ:

Esophagogastric junction

EGJOO:

EGJ outflow obstruction

FLIP:

Functional luminal imaging probe

HRM:

High-resolution manometry

IRP:

Integrated relaxation pressure

LES:

Lower esophageal sphincter

NPV:

Negative predictive value

PPV:

Positive predictive value

ROC:

Receiver operating characteristic

TBE:

Timed barium esophagogram

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Acknowledgment

The authors are very grateful to Dr. Balázs Kovács for his critical review and his assistance of English language editing.

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Authors and Affiliations

  1. Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan

    Takahiro Masuda, Fumiaki Yano, Nobuo Omura, Kazuto Tsuboi, Masato Hoshino, SeRyung Yamamoto, Shunsuke Akimoto, Yuki Sakashita, Naoko Fukushima & Hideyuki Kashiwagi

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  1. Takahiro Masuda
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  2. Fumiaki Yano
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  3. Nobuo Omura
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  4. Kazuto Tsuboi
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  5. Masato Hoshino
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  6. SeRyung Yamamoto
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  7. Shunsuke Akimoto
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  8. Yuki Sakashita
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  9. Naoko Fukushima
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  10. Hideyuki Kashiwagi
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Contributions

TM: study conception and design, acquisition of data, analysis and interpretation of results, drafting of manuscript, study supervision. FY: critical review of manuscript, acquisition of data. NO: critical review of manuscript. KT, MH, SY, SA, YS, and NF: writing assistance, acquisition of data. HK: critical review of manuscript.

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Correspondence to Takahiro Masuda.

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Masuda, T., Yano, F., Omura, N. et al. Optimal cutoff value of integrated relaxation pressure on the esophagogastric junction to detect outflow obstruction using starlet high-resolution manometry system. J Gastroenterol 56, 231–239 (2021). https://doi.org/10.1007/s00535-020-01757-w

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  • DOI: https://doi.org/10.1007/s00535-020-01757-w

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