Water-perfused esophageal high-resolution manometry: normal values and validation

Abstract

Water-perfused high-resolution manometry (HRM) catheters with 36 unidirectional pressure channels have recently been developed, but normal values are not yet available. Furthermore, the technique has not been validated and compared with solid-state HRM. We therefore aimed to develop normal values for water-perfused HRM and to assess the level of agreement between water-perfused HRM and solid-state HRM. We included 50 healthy volunteers (mean age 35 yr, range 21-64 yr; 15 women, 35 men). Water-perfused HRM and solid-state HRM were performed in a randomized order. Normal values were calculated as 5th and 95th percentile ranges, and agreement between the two systems was assessed with intraclass correlation coefficient (ICC) statistics. The 5th-95th percentile range was 3.0-6.6 cm/s for contractile front velocity (CFV), 141.6-3,674 mmHg·s·cm for distal contractile integral (DCI), 6.2-8.7 s for distal contraction latency (DL), and 1.0-18.8 mmHg for integrated relaxation pressure (IRP 4s). Mean (SD) and ICC for water-perfused HRM and solid-state HRM were 4.4 (1.1) vs. 3.9 (0.9) cm/s, ICC: 0.49 for CFV; 1,189 (1,023) vs. 1,092 (1,019) mmHg·s·cm, ICC: 0.90 for DCI; 7.4 (0.8) vs. 6.9 (0.9) s, ICC: 0.50 for DL; and 8.1 (4.8) vs. 7.9 (5.1), ICC: 0.39 for IRP 4s. The normal values for this water-perfused HRM system are only slightly different from previously published values with solid-state HRM, and moderate to good agreement was observed between the two systems, with only small differences in outcome measures.

Normative values in esophageal high‐resolution manometry

“…One other study, conducted by Kessing et al ., directly compared a solid‐state to a water‐perfused HRM system . In this study only small differences in outcome measures, such as the Chicago Classification metrics, were found.…”

“…Despite multiple factors influencing normative values, the Chicago Classification is still applicable in most situations. This is even the case when using a higher sensor interval of 2 cm in segments outside the esophagogastric junction, or to some degree when using a type of water‐perfused catheter . However, there were certain flaws in the criteria for hypercontractility and the criteria looking at break size in the 2012 version of the Chicago classification, which have now been addressed in the third version.…”

Determinants of pressure drift in Manoscan™ esophageal high‐resolution manometry system

“…The first HRM classification of esophageal motor disorders described the normative esophageal pressure metrics exclusively based on measurements with the Manoscan ™ system . Comparative studies with other HRM systems have only shown moderate to good agreement between various HRM systems, and substantial differences exist in some of the commonly used normative pressure metrics . Currently, it is unknown if other available HRM systems manifest other limitations in accuracy of their pressure measurement.…”

Characterization and follow‐up of esophagogastric junction outflow obstruction detected by high resolution manometry

“…The following manometric, impedance, and pH‐metric parameters were collected from patients with EGJOO: basal or resting pressure of the LES (LES‐RP) (normal values: 10–35 mmHg), resting pressure of the UES (UES‐RP) (normal values: 34–104mmHg), integrated relaxation pressure (IRP) (normal values IRP4s: <18 mmHg), intrabolus pressure (IBP) (normal values: <12 mmHg), pressurization presence or absence, contractile front velocity (CFV) (normal values: 3.0–6.6 cm/s), distal contractile integral (DCI) (normal values: 450–8000 mmHgm.s.cm), peristaltic defects (normal values: <5 cm), distal latency (DL) (normal values: >6.2 s), esophageal transit: complete (CET) or incomplete (IET) (we considered as normal a complete bolus clearance in at least 70% of liquid swallows), and pathological acid gastroesophageal reflux (GER) with the DeMeester score (normal values: <14.72)…”

“…These normal values (thresholds) used are based on the Chicago Classification, except the cut‐offs of technology‐specific measurements such as IRP, DL, CFV, and IBP that are based on the recently defined thresholds by Kessing et al ., for water‐perfused esophageal HRM, similar technique used in this study, and similar thresholds to those recently published by our lab, as the Chicago Classification values are set for Solid‐state HRM. Commonly accepted thresholds were used as reference values for esophageal sphincters resting pressures, esophageal bolus transit, and acid exposure, as these measurements are not included under the Chicago Classification.…”