TY - JOUR
T1 - Frequent discrepancies among diagnostic tests for detecting lower esophageal sphincter-related obstruction
AU - Reddy, Chanakyaram A.
AU - Ellison, Ashton
AU - Cipher, Daisha J.
AU - Mendoza, Roseann
AU - Souza, Rhonda F.
AU - Spechler, Stuart J.
AU - Konda, Vani J.A.
AU - Nguyen, Anh D.
N1 - Publisher Copyright:
© 2023 John Wiley & Sons Ltd.
PY - 2024/3
Y1 - 2024/3
N2 - Background: There are frequent discrepancies among high-resolution manometry (HRM), functional lumen imaging probe (FLIP), and esophagram in identifying lower esophageal sphincter (LES)-related obstruction. We aimed to determine the frequency of those discrepancies and how they influenced clinical treatment/outcomes. Methods: We identified patients who had all three tests (HRM, FLIP, and esophagram) and endoscopy performed for evaluation of esophageal symptoms in our Center for Esophageal Diseases. Discrepancies among the tests for the presence of LES obstruction were noted, and the performance of individual tests was compared against a consensus opinion rendered by a panel of esophagologists. Binary logistical regression was performed, and ROC curves were generated for prediction of the consensus clinical diagnosis of LES obstruction. Key Results: A total of 126 patients (mean age 57.9 ± 17.0 years; 67% female) met inclusion criteria. All three tests agreed on the presence or absence of LES obstruction in only 72 (57%) patients [no LES obstruction in 57 (45%), LES obstruction in 15 (12%)]. Thirteen patients (10%) had a change in management based on additional findings on FLIP +/− esophagram not seen on HRM with 69% having symptomatic improvement after LES-directed intervention. FLIP was the strongest predictor of a consensus diagnosis of LES obstruction by logistic regression and ROC (OR 23.36, AUC 0.796), followed by HRM (OR 15.41, AUC 0.764). Conclusions & Inference: High-resolution manometry, functional lumen imaging probe, and esophagram each have considerable limitations for identifying LES obstruction, and discrepancies among these tests occur frequently. Multimodal testing is often required for adequate evaluation of LES-related obstruction.
AB - Background: There are frequent discrepancies among high-resolution manometry (HRM), functional lumen imaging probe (FLIP), and esophagram in identifying lower esophageal sphincter (LES)-related obstruction. We aimed to determine the frequency of those discrepancies and how they influenced clinical treatment/outcomes. Methods: We identified patients who had all three tests (HRM, FLIP, and esophagram) and endoscopy performed for evaluation of esophageal symptoms in our Center for Esophageal Diseases. Discrepancies among the tests for the presence of LES obstruction were noted, and the performance of individual tests was compared against a consensus opinion rendered by a panel of esophagologists. Binary logistical regression was performed, and ROC curves were generated for prediction of the consensus clinical diagnosis of LES obstruction. Key Results: A total of 126 patients (mean age 57.9 ± 17.0 years; 67% female) met inclusion criteria. All three tests agreed on the presence or absence of LES obstruction in only 72 (57%) patients [no LES obstruction in 57 (45%), LES obstruction in 15 (12%)]. Thirteen patients (10%) had a change in management based on additional findings on FLIP +/− esophagram not seen on HRM with 69% having symptomatic improvement after LES-directed intervention. FLIP was the strongest predictor of a consensus diagnosis of LES obstruction by logistic regression and ROC (OR 23.36, AUC 0.796), followed by HRM (OR 15.41, AUC 0.764). Conclusions & Inference: High-resolution manometry, functional lumen imaging probe, and esophagram each have considerable limitations for identifying LES obstruction, and discrepancies among these tests occur frequently. Multimodal testing is often required for adequate evaluation of LES-related obstruction.
KW - achalasia
KW - esophageal motility disorders
KW - esophagogastric junction outflow obstruction (EGJOO)
KW - functional lumen imaging probe (FLIP)
KW - high-resolution manometry (HRM)
UR - http://www.scopus.com/inward/record.url?scp=85180190107&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85180190107&partnerID=8YFLogxK
U2 - 10.1111/nmo.14729
DO - 10.1111/nmo.14729
M3 - Article
C2 - 38129627
AN - SCOPUS:85180190107
SN - 1350-1925
VL - 36
JO - Neurogastroenterology and Motility
JF - Neurogastroenterology and Motility
IS - 3
M1 - e14729
ER -