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

Iwaya, Yugo; Inoue, Haruhiro; Santiago, Enrique Rodríguez de; Abad, Mary Raina Angeli; Fujiyoshi, Yusuke; Ueno, Akihisa; Tanabe, Minoru; Sumi, Kazuya; Tomida, Hideomi; Ominami, Masaki; Ikeda, Haruo; Onimaru, Manabu; Shimamura, Yuto

doi:10.1111/den.13644

Cited by 10 publications

(17 citation statements)

References 25 publications

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“…T HE PERFORMANCE OF EPSIS has been previously investigated in a pilot study. 5,6 Our group reported that a flat waveform pattern of IGP and an IGP max under 18.7 mmHg could distinguish acid reflux from disorders with similar symptoms with good accuracy. 5 In order to enhance the accuracy and reproducibility of this diagnostic system, the waveform of IGP was characterized in detail by obtaining objective parameters, rather than applying uphill or flat pattern criteria, which can sometimes be subjective.…”

Section: Discussionmentioning

confidence: 99%

“…Exclusion criteria were age <18 years, pregnancy, or history of upper gastrointestinal surgery or enrollment in prior EPSIS studies at our institution. 5,6 All study participants underwent EGD, EPSIS, and MII-pH. In selected cases, histopathologic assessment and highresolution manometry were performed to rule out eosinophilic esophagitis and major motility disorders at the discretion of endoscopists.…”

Section: Study Design and Patientsmentioning

confidence: 99%

“…A subsequent report also showed that EPSIS had a significant association with the presence of erosive esophagitis and Barrett's esophagus. 6 These findings suggest that EPSIS can be regarded as a tolerance test to assess lower esophageal sphincter (LES) function by merely insufflating CO 2 in the stomach. Nonetheless, there are cases in which characterizing waveform pattern into either of these two patterns (uphill or flat pattern) can be challenging and subjective.…”

Section: Introductionmentioning

confidence: 99%

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Characterization of intragastric pressure waveform in endoscopic pressure study integrated system: Novel diagnostic device for gastroesophageal reflux disease

Shimamura

Inoue

Santiago

et al. 2020

Digestive Endoscopy

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Objectives Endoscopic pressure study integrated system (EPSIS) is a novel diagnostic tool for gastroesophageal reflux disease (GERD). EPSIS has been developed to evaluate lower esophageal sphincter function by monitoring the intragastric pressure (IGP) while insufflating the stomach during gastroscopy. Based on previous data, EPSIS could diagnose GERD with good accuracy by assessing IGP waveform pattern. This study aimed to further characterize the waveform to improve the diagnostic yield of EPSIS. Methods We conducted a retrospective analysis of patients with typical GERD symptoms who underwent both EPSIS and 24‐h impedance‐pH monitoring (MII‐pH) at a single tertiary referral center from October 2018 to May 2020. EPSIS was performed by using a through‐the‐scope catheter connected to the pressure measuring system (TR‐W550, TR‐TeH08, AP‐C35; Keyence, Osaka, Japan) to monitor IGP. Abnormal acid reflux was defined as acid exposure time (AET) over 6.0%. Pressure waveform was characterized as follows: (i) Basal IGP, (ii) Maximum IGP, (iii) Pressure difference, (iv) Gradient of the waveform. Results A total of 57 patients with GERD symptoms were analyzed. Twenty‐one patients presented abnormal AET on MII‐pH. Among EPSIS parameters, pressure difference during insufflation correlated with AET (ρ = −0.66, P < 0.01) and showed the best diagnostic accuracy for AET with the cutoff value of 4.7 mmHg (area under the curve [AUC], 0.87). The gradient of EPSIS waveform also revealed good diagnostic accuracy for abnormal AET with the cutoff value of 0.07 mmHg/s (AUC, 0.81). Conclusions Endoscopic pressure study integrated system waveform parameters, especially pressure difference, presented high diagnostic accuracy for the presence of abnormal acid reflux.

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Section: Discussionmentioning

confidence: 99%

Section: Study Design and Patientsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Characterization of intragastric pressure waveform in endoscopic pressure study integrated system: Novel diagnostic device for gastroesophageal reflux disease

Shimamura

Inoue

Santiago

et al. 2020

Digestive Endoscopy

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“…Our previous reports showed that low maximum IGP and flat pattern are significant predictors of gastroesophageal reflux disease (GERD) 1 . Furthermore, EPSIS correlated with erosive esophagitis and Barrett’s esophagus 2 . As such, EPSIS can be used for the diagnosis of acid reflux during initial upper endoscopy assessment.…”

Section: Introductionmentioning

confidence: 98%

“…1 Furthermore, EPSIS correlated with erosive esophagitis and Barrett's esophagus. 2 As such, EPSIS can be used for the diagnosis of acid reflux during initial upper endoscopy assessment. It is a safe tool that requires only CO 2 insufflation for a short period of time.…”

Section: Introductionmentioning

confidence: 99%

Simplified endoscopic pressure study integrated system for the diagnosis of gastroesophageal reflux disease

Nishikawa

Inoue

Shimamura

et al. 2021

Digestive Endoscopy

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Endoscopic pressure study integrated system (EPSIS) is a novel tool for the diagnosis of gastroesophageal reflux disease. It enables the evaluation of the function of the lower esophageal sphincter by monitoring intragastric pressure (IGP) while insufflating the stomach during esophagogastroduodenoscopy. EPSIS can predict abnormal acid reflux with high accuracy based on previous studies. IGP was measured by inserting through the working channel of the scope an intragastric catheter connected to a pressure measuring device. Herein, we assess the feasibility of an updated EPSIS system, which can be performed just by connecting a flush tube to the working channel. This method does not require inserting foreign objects in the stomach and spares catheter insertion in order to simplify the procedure and reduce costs. A single-center pilot study was conducted to evaluate the association between catheter-based EPSIS and the updated EPSIS. The results of EPSIS in 20 patients who underwent both methods were assessed. In all cases, the waveform pattern of IGP measured by catheter-based EPSIS and updated EPSIS was consistent with 15 uphill pattern and five flat pattern. Intraobserver agreement of waveform pattern was perfect between two examiners with kappa value = 1. Intraclass correlation coefficient (ICC) for intraobserver reliability for maximum IGP was excellent with 0.91 (95% confidence interval [CI] of 0.77 < ICC < 0.96) and for pressure gradient was also good with 0.89 (95% CI of 0.71 < ICC < 0.95). In conclusion, our study suggests that the updated EPSIS can be performed without the use of a catheter.

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Comparison of scope holding sign on endoscopy and lower esophageal sphincter contraction on high‐resolution manometry: A pilot study

et al. 2021

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Objectives Lower esophageal sphincter (LES) plays a key role in gastroesophageal reflux disease (GERD) pathogenesis. In retroflexion and under sufficient insufflation, it can be seen how the lower esophagus grasps the endoscope, which we named scope holding sign (SHS). This study aimed to compare the SHS and LES pressure on high‐resolution manometry (HRM), to elucidate whether the sphincter can be visualized endoscopically. Methods This was a single‐center, prospective pilot study. Patients with symptoms of GERD, who underwent endoscopy and HRM between February 2021 and April 2021, were included. A manometry catheter and an ultra‐slim endoscope were inserted, and the resting LES pressure was measured. The lower esophagus holding (SHS‐positive) and releasing (SHS‐negative) the endoscope and catheter were observed. The LES pressures during SHS‐positive and SHS‐negative were compared. Results Eleven patients (median age: 57 years; eight men) with normal esophageal motility were analyzed. The median LES pressure in SHS‐positive was significantly higher than the resting LES pressure (40.4 [22.9–74.0] vs. 25.9 [2.0–66.7] mm Hg; p = 0.001) and the LES pressure in SHS‐negative (4.6 [1.5–9.3]; p = 0.001). Furthermore, the LES pressure in SHS‐negative was significantly lower than the resting LES pressure (4.6 [1.5–9.3] vs. 25.9 [2.0–66.7] mm Hg; p = 0.005). Conclusions This study demonstrated that the SHS parallels LES pressure, indicating that the sphincter can be observed endoscopically. This may enable us to evaluate LES function during endoscopy in patients with GERD, thus, deserving further evaluation in future studies.

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

Cited by 10 publications

References 25 publications

Characterization of intragastric pressure waveform in endoscopic pressure study integrated system: Novel diagnostic device for gastroesophageal reflux disease

Characterization of intragastric pressure waveform in endoscopic pressure study integrated system: Novel diagnostic device for gastroesophageal reflux disease

Simplified endoscopic pressure study integrated system for the diagnosis of gastroesophageal reflux disease

Comparison of scope holding sign on endoscopy and lower esophageal sphincter contraction on high‐resolution manometry: A pilot study

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