Characterization of intragastric pressure waveform in endoscopic pressure study integrated system: Novel diagnostic device for gastroesophageal reflux disease.
endoscopic diagnosis
endoscopy
esophagus
gastroesophageal reflux disease
Journal
Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society
ISSN: 1443-1661
Titre abrégé: Dig Endosc
Pays: Australia
ID NLM: 9101419
Informations de publication
Date de publication:
Jul 2021
Jul 2021
Historique:
revised:
01
10
2020
received:
02
08
2020
accepted:
04
10
2020
pubmed:
11
10
2020
medline:
29
7
2021
entrez:
10
10
2020
Statut:
ppublish
Résumé
Endoscopic pressure study integrated system (EPSIS) is a novel diagnostic tool for gastroesophageal reflux disease (GERD). EPSIS has been developed to evaluate lower esophageal sphincter function by monitoring the intragastric pressure (IGP) while insufflating the stomach during gastroscopy. Based on previous data, EPSIS could diagnose GERD with good accuracy by assessing IGP waveform pattern. This study aimed to further characterize the waveform to improve the diagnostic yield of EPSIS. We conducted a retrospective analysis of patients with typical GERD symptoms who underwent both EPSIS and 24-h impedance-pH monitoring (MII-pH) at a single tertiary referral center from October 2018 to May 2020. EPSIS was performed by using a through-the-scope catheter connected to the pressure measuring system (TR-W550, TR-TeH08, AP-C35; Keyence, Osaka, Japan) to monitor IGP. Abnormal acid reflux was defined as acid exposure time (AET) over 6.0%. Pressure waveform was characterized as follows: (i) Basal IGP, (ii) Maximum IGP, (iii) Pressure difference, (iv) Gradient of the waveform. A total of 57 patients with GERD symptoms were analyzed. Twenty-one patients presented abnormal AET on MII-pH. Among EPSIS parameters, pressure difference during insufflation correlated with AET (ρ = -0.66, P < 0.01) and showed the best diagnostic accuracy for AET with the cutoff value of 4.7 mmHg (area under the curve [AUC], 0.87). The gradient of EPSIS waveform also revealed good diagnostic accuracy for abnormal AET with the cutoff value of 0.07 mmHg/s (AUC, 0.81). Endoscopic pressure study integrated system waveform parameters, especially pressure difference, presented high diagnostic accuracy for the presence of abnormal acid reflux.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
780-787Informations de copyright
© 2020 Japan Gastroenterological Endoscopy Society.
Références
Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol 2013; 108: 308-28; quiz 29.
Richter JE, Rubenstein JH. Presentation and epidemiology of gastroesophageal reflux disease. Gastroenterology 2018; 154: 267-76.
Herregods TV, Bredenoord AJ, Smout AJ. Pathophysiology of gastroesophageal reflux disease: New understanding in a new era. Neurogastroenterol Motil 2015; 27: 1202-13.
Gyawali CP, Kahrilas PJ, Savarino E et al. Modern diagnosis of GERD: The lyon consensus. Gut 2018; 67: 1351-62.
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: 759-62.
Iwaya Y, Inoue H, de Santiago ER 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. https://doi.org/10.1111/den.13644
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.e73.
Kahrilas PJ, Shi G, Manka M, Joehl RJ. Increased frequency of transient lower esophageal sphincter relaxation induced by gastric distention in reflux patients with hiatal hernia. Gastroenterology 2000; 118: 688-95.
Suzuki T, Hirano M, Yamamoto Y. Examination of visceral perception and gastric tone by gastric stimulation using air inflation during endoscopy. J Int Med Res 2005; 33: 160-9.
Frankhuisen R, Van Herwaarden MA, Scheffer R, Hebbard GS, Gooszen HG, Samsom M. Increased intragastric pressure gradients are involved in the occurrence of acid reflux in gastroesophageal reflux disease. Scand J Gastroenterol 2009; 44: 545-50.
Holzer P, Painsipp E, Jocic M, Heinemann A. Acid challenge delays gastric pressure adaptation, blocks gastric emptying and stimulates gastric fluid secretion in the rat. Neurogastroenterol Motil 2003; 15: 45-55.
Hartley MN, Walker SJ, Mackie CR. Abnormal gastric adaptive relaxation in patients with gastrooesophageal reflux. Gut 1990; 31: 500-3.
Vegesna A, Besetty R, Kalra A et al. Induced opening of the gastroesophageal junction occurs at a lower gastric pressure in gerd patients and in hiatal hernia subjects than in normal control subjects. Gastroenterol Res Pract 2010; 2010: 857654.