Normal Values of Esophageal High-Resolution Manometry: A Brazilian Multicenter Study

Abstract

BACKGROUND: The high-resolution manometry has been a significant advance in esophageal diagnostics. There are different types of catheter and systems devices to capture esophageal pressures that generate variable data related to Chicago Classification (CC) and consequently influence normal values results. There are not normative data for the 24-channel water-perfused high-resolution manometry system most used in Brazil with healthy volunteers in supine posture. OBJECTIVE: To determine manometric esophageal normative values for a 24-channel water-perfused high-resolution manometry catheter in supine posture using healthy volunteers according to CC 3.0 parameters. METHODS: A total of 92 volunteers with no gastrointestinal symptoms or medications affecting GI motility underwent esophageal high-resolution manometry by standard protocol. Age, gender and manometry parameters analyzed using Alacer software were collected. The median, range, and 5th and 95th percentiles (where applicable) were obtained for all high-resolution manometry metrics. Normal value percentiles were defined as 95th integrated relaxation pressure, 5th-100th distal contractile integral, and 5th distal latency. RESULTS: The mean age was 40.5±13.2 years. Our normative metrics were integrated relaxation pressure <16 mmHg and distal contractile integral (708-4111 mmHg.cm.s) distal latency was <6 s and peristaltic break size (>4 cm). For EGJ-CI the range 5th-95th was 21.7-86.9 mmHg.cm.s. CONCLUSION: This is the first report of normative data for the 24-channel water-perfused system in supine posture. It revealed higher integrated relaxation pressure and distal latency duration which suggest the need to change CC 3.0 cutoffs for this system. It is observed that there is a tendency that DCI >7000 mmHg.cm.s may represent the lower limit of hypercontractility, and when <700 mmHg.cm.s (<5% percentile) interpreted as ineffective esophageal motility or failcontraction. Also compared to Chicago 3.0, higher integrated relaxation pressure and duration of distal latency were found. We emphasize that these data must be confirmed by future studies.

Esophagogastric junction morphology and contractile integral on high‐resolution manometry in asymptomatic healthy volunteers: An international multicenter study

“…Of note, EGJ‐CI values below the 25th percentile (22.1, 23.6, and 35.0 mmHg.cm in Diversatek, Medtronic, and Laborie, respectively) overlapped much less with values between the 25th percentile (3‐20 mmHg.cm) and 75th percentile (21.0‐63.0 mmHg.cm) in GERD patients, albeit using different gastric baseline thresholds 11,14,15,17‐20 . Limited data using a 24‐channel, water‐perfused HRM system manufactured by a Brazilian company suggested higher thresholds (5th percentile, 21.7 mmHg.cm; 25th percentile, 34.3 mmHg.cm) 21 . In another small subset of patients studied using 3D Medtronic HRM catheter, median EGJ‐CI values were higher (65.4, IQR 52.3‐98.9 mmHg.cm) when calculated at 2 mm Hg above the gastric baseline 3 .…”

“…11,14,15,[17][18][19][20] Limited data using a 24-channel, water-perfused HRM system manufactured by a Brazilian company suggested higher thresholds (5th percentile, 21.7 mmHg.cm; 25th percentile, 34.3 mmHg.cm). 21 In another small subset of patients studied F I G U R E 3 Correlation between A. esophagogastric junction contractile integral (EGJ-CI) and basal lower esophageal sphincter pressure (LESP), and B. EGJ-CI and end-expiratory LESP. Correlation was stronger with Medtronic and Laborie systems.…”

Cardiomiotomia com fundoplicatura videolaparoscópica em comparação à miotomia endoscópica peroral em pacientes portadores de acalasia do esôfago

“…Técnicas manométricas convencionais e análise de rastreamento (intervalo de 3 cm a 5 cm) podem ser utilizadas para representar o perfil de pressão do músculo liso do esôfago; no entanto, com a MAR todo o esôfago pode ser analisado, o que é útil para prever não apenas a presença de acalasia, mas também a resposta ao tratamento (Ou et al, 2016;Pandolfino e Gawron, 2015;Patel et al, 2017;Domingues et al, 2020).…”