Comparison of two high‐resolution manometry software systems in evaluating esophageal motor function

Abstract

Background High-resolution manometry (HRM) utilizes software tools to diagnose esophageal motor disorders. Performance of these software metrics could be affected by averaging and by software characteristics of different manufacturers. Methods HRM studies on 86 patients referred for antireflux surgery (61.6±1.4 yr, 70% F) and 20 healthy controls (27.9±0.7 yr, 45% F) were first subject to standard analysis (Medtronic, Duluth, GA). Coordinates for each of 10 test swallows were exported and averaged to generate a composite swallow. The swallows and averaged composites were imported as ASCII file format into Manoview (Medtronic, Duluth, GA) and Medical Measurement Systems database reporter (MMS, Dover, NH), and analyses repeated. Comparisons were made between standard and composite swallow interpretations. Results Correlation between the two systems was high for mean distal contractile integral (DCI, r2≥0.9) but lower for integrated relaxation pressure (IRP, r2=0.7). Excluding achalasia, six patients with outflow obstruction (mean IRP 23.2±2.1 with 10-swallow average) were identified by both systems. An additional 9 patients (10.5%) were identified as outflow obstruction (15 mmHg threshold) with MMS 10-swallow and 4 with MMS composite swallow evaluation; only one was confirmed. IEM was diagnosed by 10 swallow evaluation in 19 (22.1%) with Manoview, and 20 (23.3%) with MMS. On Manoview composite, 17 had DCI<450 mmHg.cm.s, and on MMS composite, 21, (p≥0.85 for each comparison) but these did not impact diagnostic conclusions. Conclusions Comparison of 10 swallow and composite swallows demonstrate variability of software metrics between manometry systems. Our data supports use of manufacturer specific software metrics on 10 swallow sequences.

Esophageal Baseline Impedance From High-resolution Impedance Manometry Correlates With Mean Nocturnal Baseline Impedance From pH-impedance Monitoring

“…The HRIM catheters differ in sensor morphology between these manufacturers––the Diversatek pressure sensors protrude from the catheter, while the Medtronic pressure sensors are more embedded along the catheter. Prior work has demonstrated variability in HRM software metrics (including integrated relaxation pressures) between solid-state manometry systems, 31 - 35 and the Chicago classification therefore acknowledges differences in threshold values for HRM metrics based on manometry systems (particularly for integrated relaxation pressures). 17 Although these differences in solid-state manometry pressure sensors and metrics are established, similar investigations into potential differences in impedance sensing between manometry systems have not been performed, to our knowledge.…”

Variation in esophageal physiology testing in clinical practice: Results from an international survey

“…The absolute values obtained during clinical studies vary especially for the assessment of key landmarks (e.g. EGJ and LES) . Investigation in the supine position remains the widely accepted position for performing tests, but 42% of units surveyed investigate patients also in the physiological upright sitting position .…”

“…EGJ and LES). 23,[26][27][28][29][30] Investigation in the supine position remains the widely accepted position for performing tests, but 42% of units surveyed investigate patients also in the physiological upright sitting position. 21,31,32 This further reduces standardization as results from upright and supine positions are not always identical, although it is very unusual for position to impact on diagnosis of major motility disorders.…”

A fuzzy-based framework for diagnosing esophageal mobility disorder using high-resolution manometry

“…Although the Chicago guideline provides a determined methodology and facilitates diagnosis, several complications remain: For instance, HRM pressure values depend on technology and are not equal among different devices. As a result, xed thresholds of Chicago classi cation could lead to misdiagnosis in clinical practice [5,6]. Furthermore, external variables, such as the patient's age, body mass index, and racial background, can affect normative values [7].…”