137a Inter-Observer Agreement for Manometry Classification of Individual Swallows and Diagnoses Using High-Resolution Manometry (HRM) With Esophageal Pressure Topography (EPT): Results of Web-Based Studies With High Participation

Fox, Mark; Pandolfino, John E.; Jafari, Jafar; Menne, Dieter; Abreu, A.T. Abreu y; Bogte, Auke; Elvevi, Alessandra; León, Antonio Ruiz de; Kessing, Boudewijn Ff; Boris, Lubomyr; Troche, José M. Remes; Gyawali, C. Prakash; Wilshire, Candice L.; Wasko-Czopnik, Dorata; Mion, François; Fruehauf, Heiko; Zerbib, Frank; Gellersen, Oliver; Heinrich, Henriette; Serna, Julio; Sauter, Matthias; Hemmink, Gerrit J.; Banasiuk, Marcin; Valdovinos, Miguel A.; Uścinowicz, Mirosława; Kwiatek, Monika A.; Wright, Jeff; Weijenborg, Pim W.; Sweis, Rami; Roman, Sabine; Vardar, Rukiye; Ghosh, Sudip Kumar; Tutuian, Radu; Rohof, Wout O.; Bredenoord, Albert J.

doi:10.1016/s0016-5085(12)60133-4

Cited by 3 publications

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“…The study took place from January to March 2011. Initial results were discussed at the HRM Working Group Meeting in Ascona, April 2011, with results presented at Digestive Diseases Week in San Diego, May 2012 …”

Section: Methodsmentioning

confidence: 99%

Inter-observer agreement for diagnostic classification of esophageal motility disorders defined in high-resolution manometry

et al. 2014

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High-resolution esophageal manometry (HRM) is a recent development used in the evaluation of esophageal function. Our aim was to assess the inter-observer agreement for diagnosis of esophageal motility disorders using this technology. Practitioners registered on the HRM Working Group website were invited to review and classify (i) 147 individual water swallows and (ii) 40 diagnostic studies comprising 10 swallows using a drop-down menu that followed the Chicago Classification system. Data were presented using a standardized format with pressure contours without a summary of HRM metrics. The sequence of swallows was fixed for each user but randomized between users to avoid sequence bias. Participants were blinded to other entries. (i) Individual swallows were assessed by 18 practitioners (13 institutions). Consensus agreement (≤ 2/18 dissenters) was present for most cases of normal peristalsis and achalasia but not for cases of peristaltic dysmotility. (ii) Diagnostic studies were assessed by 36 practitioners (28 institutions). Overall inter-observer agreement was 'moderate' (kappa 0.51) being 'substantial' (kappa > 0.7) for achalasia type I/II and no lower than 'fair-moderate' (kappa >0.34) for any diagnosis. Overall agreement was somewhat higher among those that had performed >400 studies (n = 9; kappa 0.55) and 'substantial' among experts involved in development of the Chicago Classification system (n = 4; kappa 0.66). This prospective, randomized, and blinded study reports an acceptable level of inter-observer agreement for HRM diagnoses across the full spectrum of esophageal motility disorders for a large group of clinicians working in a range of medical institutions. Suboptimal agreement for diagnosis of peristaltic motility disorders highlights contribution of objective HRM metrics.

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Section: Methodsmentioning

confidence: 99%

Inter-observer agreement for diagnostic classification of esophageal motility disorders defined in high-resolution manometry

et al. 2014

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“…Furthermore, anatomic landmarks are easier to identify, catheter placement and data acquisition take less time, 87 study analysis is easier 49,50 , and assessment of esophageal function is more accurate than with conventional manometry 47,53 . Inter‐observer agreement of HRM diagnosis across a large number of researchers and institutions is at least as high as similar reports for conventional manometry from a single center 88 …”

Section: Manometric Techniques and Analysismentioning

confidence: 97%

Evaluation of esophageal motor function in clinical practice

Gyawali

Bredenoord

Conklin

et al. 2013

Neurogastroenterology Motil

113

119

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Esophageal motor function is highly coordinated between central and enteric nervous systems and the esophageal musculature, which consists of proximal skeletal and distal smooth muscle in three functional regions, the upper and lower esophageal sphincters, and the esophageal body. While upper endoscopy is useful in evaluating for structural disorders of the esophagus, barium esophagography, radionuclide transit studies, and esophageal intraluminal impedance evaluate esophageal transit and partially assess motor function. However, esophageal manometry is the test of choice for the evaluation of esophageal motor function. In recent years, high-resolution manometry (HRM) has streamlined the process of acquisition and display of esophageal pressure data, while uncovering hitherto unrecognized esophageal physiologic mechanisms and pathophysiologic patterns. New algorithms have been devised for analysis and reporting of esophageal pressure topography from HRM. The clinical value of HRM extends to the pediatric population, and complements preoperative evaluation prior to foregut surgery. Provocative maneuvers during HRM may add to the assessment of esophageal motor function. The addition of impedance to HRM provides bolus transit data, but impact on clinical management remains unclear. Emerging techniques such as 3-D HRM and impedance planimetry show promise in the assessment of esophageal sphincter function and esophageal biomechanics.

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