Assessing Bolus Retention in Achalasia Using High-Resolution Manometry With Impedance: A Comparator Study With Timed Barium Esophagram

Abstract

Background The aim of this study was to assess whether high-resolution impedance-manometry (HRIM) could be utilized to assess bolus retention similar to the timed barium esophagram (TBE). Method 20 achalasia patients [10 males, ages 21–79] were prospectively evaluated with HRIM and TBE to determine the correlation between barium column height and the impedance bolus height (IBH). The TBE protocol utilized a 200 ml barium challenge and the HRIM protocol utilized a 200 ml saline challenge protocol. Both protocols were performed in an upright position and the heights of the barium and impedance columns were measured at 1 and 5 minutes. Analysis of IBH was performed with a topographic technique and a spatial impedance variation plot. Results There was no significant difference between the median IBH and barium column at 1 minute [IBH 12.0 cm (IQR, 8.0–18.0), TBE 12.0 cm (IQR, 7.0–19.0), P=0.90] or 5 minutes [IBH 11.0 cm (IQR, 1.0–17.0), TBE 9.0 cm (IQR, 4.0–12.0), P=0.47]. Additionally, the correlation between the two measurements at 1 and 5 minutes was 0.60 and 0.86, respectively. Using a barium column or impedance height of >5.0 as a definition of bolus retention was associated with 75% concordance at 1 minute and 95% concordance at 5 minutes. Conclusion There was excellent agreement between TBE and HRIM for assessing bolus retention at 5 minutes. Thus, HRM with impedance may be utilized as a single test to assess bolus retention and motor function in the management of achalasia.

Early esophagram in per-oral endoscopic myotomy (POEM) for achalasia does not predict long-term outcomes

“…Besides TBE, novel techniques for evaluating functional outcomes such as combined high-resolution impedance manometry and the functional lumen imaging probe have been used in the perioperative evaluation of patients with achalasia and represent future avenues of research. [23][24][25] In this study, the finding of delayed passage of contrast on POD#1 esophagram did not predict long-term symptomatic or functional outcomes, or the need for reintervention, in patients undergoing POEM for achalasia. Because of the large number of false-positive findings and limited clinical utility in evaluating asymptomatic patients for leak, routine early esophagram has been eliminated from the post-POEM protocol at our institution.…”

Correlation Between Timed Barium Esophagogram and Esophageal Transit Scintigraphy Results in Achalasia

“…A LES pressure below 10 mmHg determined by manometry is the most effective predictor of long-term achalasia treatment success [18]. Manometry is known as the most accurate method of achalasia diagnosis and evaluation, and it enables both quantitative and qualitative assessments of esophageal motility function [19][20][21]. Recently published paper also suggested the impedance bolus height on HRM has a correlation with manometric variables when compared to barium column height on TBE [2].…”

Oesophageal dysphagia: manifestations and diagnosis

“…35,36 Finally, impedance measurements might give the potential to assess oesophageal passive drainage in patients with achalasia. 37,38 When combined with pressure measurements of the EGJ, impedance measurements could provide a broader scope of mechanistic information than that currently available using a timed barium oesophagram test and have a greater role in the diagnosis of dysphagia than originally envisaged.…”