Diagnostic performance of the endoscopic pressure study integrated system (EPSIS): a novel diagnostic tool for gastroesophageal reflux disease

Abstract

Background The endoscopic pressure study integrated system (EPSIS) is a prototypic system for monitoring intragastric pressure (IGP) fluctuations that result from opening of the cardia during gastric distension. The performance of EPSIS for the diagnosis of gastroesophageal reflux disease (GERD) was evaluated. Methods A retrospective analysis was conducted of data prospectively collected over a 2-year period from 59 patients who underwent gastroscopy, EPSIS, and 24-hour pH monitoring. Using a dedicated electronic device and a through-the-scope catheter, maximum IGP (IGPmax) and IGP waveform pattern (uphill/flat) were recorded. Results The optimal IGPmax cutoff was 18.7 mmHg. IGPmax < 18.7 mmHg (sensitivity 74.2 %, 95 % confidence interval [CI] 56.8 – 86.3; specificity 57.1 %, 95 %CI 39.1 – 73.5) and flat pattern (sensitivity 71.0 %, 95 %CI 53.4 – 83.9; specificity 82.1 %, 95 %CI 64.4 – 92.1) were associated with GERD. “Double” EPSIS positivity (IGPmax < 18.7 mmHg and flat pattern) provided maximum specificity (85.7 %, 95 %CI 68.5 – 94.3), whereas “any” EPSIS positivity (IGPmax < 18.7 mmHg or flat pattern) provided maximum sensitivity (80.6 %, 95 %CI 63.7 – 90.8). Maximum specificity and sensitivity for nonerosive reflux disease (NERD) was > 70 %. In multivariate analysis, “double” EPSIS positivity was the strongest predictor of GERD (odds ratio [OR] 16.05, 95 %CI 3.23 – 79.7) and NERD (OR 14.7, 95 %CI 2.37 – 90.8). Conclusion EPSIS emerges as a reliable adjunct to routine gastroscopy for GERD diagnosis, and might prove helpful for the stratification and management of patients with reflux disorders.

Endoscopic pressure study integrated system reflects gastroesophageal junction competence in patients with erosive esophagitis and Barrett´s esophagus

“…Two examiners checked the waveform and determined the pattern in all cases. See our previous report10 for more details.…”

“…Multivariable logistic regression models were employed to identify clinical, endoscopic, and EPSIS predictors of erosive esophagitis and BE. We defined “EPSIS positivity” as IGP‐max ≤ 18.7 mmHg and a flat pattern to maximize specificity as previously reported 10. Clinically relevant variables with a P value < 0.1 in the univariate analysis were included in the multivariate logistic regression analysis.…”

“…However, few studies have investigated the association between BE and LES function 11,12,13. In our previous pilot report, the results of EPSIS were well correlated with acid reflux monitored by 24‐hour pH‐monitoring, suggesting EPSIS can reflect LES function 10. Herein, we aimed to elucidate the association between EPSIS results and endoscopically significant GERD‐related disorders; i.e., erosive esophagitis (EE) and BE.…”

“…We focused on this phenomenon and hypothesized that we might be able to estimate LES function endoscopically by preloading LES using CO 2 insufflation and induce cardia opening by monitoring the intragastric pressure (IGP) and its fluctuating pattern. Based on this idea, we developed a novel diagnostic tool; that is, an endoscopic pressure study integrated system (EPSIS) that allows monitoring of IGP fluctuations resulting from the cardia opening, induced by CO 2 ‐insufflation during endoscopy, and we reported its diagnostic usefulness for GERD 10…”

Diffuse esophageal spasm in which twitching appears due to insufflation evaluation

“…During endoscopic diagnosis, insufflation and deaeration are important not only for finding lesions of the gastrointestinal tract but also for assessing the depth of cancer. Studies on endoscopic pressure study integrated system 1 and scope holding sign 2 of the lower esophagus revealed that the lower esophageal sphincter is visualized endoscopically by insufflation, and the function can be reflected. Rosette sign 3 in achalasia is considered to be indirectly recognized as the abnormal movement of the esophagus by insufflation and deep inspiration.…”