High-resolution Manometry: Esophageal Disorders Not Addressed by the "Chicago Classification"

Wang, Yu Tien; Yazaki, Etsuro; Sifrim, Daniel

doi:10.5056/jnm.2012.18.4.365

Cited by 47 publications

(24 citation statements)

References 44 publications

(40 reference statements)

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“…It is thus feasible that CPH can contribute to dysphagia and impede intubation. Cricopharyngeal hypertrophy has also been found in association with neurological disorders [16], myositis [17] and, as with our study, with ZD [16]. It has been proposed that ZD could be a consequence of CPH [15].…”

Section: Predictors Of Abnormal Radiology In Patients With Ifsupporting

confidence: 68%

“…In a case series of 618 patients [16], CPH was observed in 10.8%, increased with age, and was associated with the obstruction of a pharyngeal bolus or cricopharyngeal indentation of the oesophagus during different phases of swallowing. On manometry, CPH has been correlated with reduced compliance and raised intrabolus pressures at the upper oesophageal sphincter [17,18]. It is thus feasible that CPH can contribute to dysphagia and impede intubation.…”

Section: Predictors Of Abnormal Radiology In Patients With Ifmentioning

confidence: 99%

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Intubation Failure During Gastroscopy: Incidence, Predictors and Follow-Up Findings

Siau

Fisher

et al. 2017

JGLD

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Background: Intubation failure (IF) occurs when an endoscopist is unable to progress via the oropharynx into the upper oesophagus. Aim: To assess incidence and aetiology of IF and predictors of structural pharyngeal abnormalities in patients with IF.Methods: All gastroscopies (n=26,130) performed in our centre, between August 2010 and August 2016 were retrospectively reviewed. Barium radiology and repeat gastroscopy findings were evaluated for structural causes of IF. Patients were categorised into ‘failure to tolerate’ and ‘failure to progress’ based on endoscopy reports.Results: The incidence of IF was 0.95%. Rates of IF varied with endoscopist specialty (p=0.021), but not with patient age, sex or sedation dose. Among cases of IF, structural pharyngeal abnormalities were detected on barium radiology in 28.9%, consisting of cricopharyngeal hypertrophy and/or Zenker’s diverticulum in 73.2%. ‘Failure to progress’ predicted pharyngeal pathology in 55.6%. Predictors of structural causes on barium radiology following IF included: age ≥65 (OR 4.0, 95% CI: 1.8-8.9, p<0.001); indication of dysphagia (OR 5.5, 95% CI: 2.5-11.8, p<0.001), and failure of endoscopic progression (OR 5.2, 95% CI: 2.3-12.0, p<0.001).Conclusion: Patients with IF should be investigated owing to the high risk of underlying pathology, particularly if associated with age ≥65, dysphagia, and failure of endoscopic progression. We propose that IF rates of <1% could be used as a quality indicator in gastroscopy. .Abbreviations: ASGE: Association for Gastrointestinal Endoscopy; CI: Confidence interval; CP: Cricopharyngeus; CPH: Cricopharyngeal hypertrophy; FESD: Flexible endoscopic septum division; GRS: Global rating scale; IF: Intubation failure; JAG: Joint Advisory Group for gastrointestinal endoscopy; NME: Non-medical endoscopist; OR: Odds ratio; SI: Successful intubation; ZD: Zenker’s diverticulum.

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Section: Predictors Of Abnormal Radiology In Patients With Ifsupporting

confidence: 68%

Section: Predictors Of Abnormal Radiology In Patients With Ifmentioning

confidence: 99%

Intubation Failure During Gastroscopy: Incidence, Predictors and Follow-Up Findings

Siau

Fisher

et al. 2017

JGLD

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“…Arndorfer разработал перфузионную систему для манометрии пищевода. Эта перфузионная система оказалась высокочувствительной, позволи-ла точно определить амплитуду сокращений в пище-воде и давление в НПС [9,10]. Существенный вклад в разработку и усовершенствование методов изучения нарушений двигательной функции пищевода и ниж-него пищеводного сфинктера внесли такие ученые, как В.Х.…”

Section: Introductionunclassified

Манометрія В Дослідженні Рухової Функції Верхніх Відділів Травної Системи

Stepanov¹,

Ratchik²,

Prolom³

et al. 2021

GASTRO

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“…Obviously, such utility of HRM may not be obtained if only "intuitive" visual inspection of motility tracing is performed and the Chicago classification system is not followed. Even though the current Chicago classification has limitations and with time [16], it is expected to improve and benefit the patients with esophageal motility disorders more.…”

mentioning

confidence: 99%

Chicago classification of high-resolution esophageal manometry: Is old the gold or is new better?

Ghoshal

2014

Indian J Gastroenterol

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High-resolution manometry (HRM), a landmark concept in gastrointestinal motility study, was introduced in the early 1990s by Clouse and Staiano [1]. In this new technology, pressure profile is assessed during several liquid and viscous swallows using a catheter having a large number of ports at closely spaced positions in the esophagus [2]. Time, catheter position, and average pressure are then reconstructed into pseudo-3D "topographic plots" that demonstrated the functional anatomy of the esophagus and that of the gastroesophageal junction taking gastric pressure as the baseline [2].There are several advantages of HRM over conventional manometry [2][3][4][5][6][7]. The advantages may be broadly classified into two groups, (a) those related to the recording of the data and (b) those related to the display of the data. The advantages of HRM over conventional manometry with respect to the data recording include (a) higher number of sensors that record lumen-occlusive contractions of the circular muscle of esophagus (typically six to eight ports in the earlier conventional manometry in contrast to 32 ports in current HRM), (b) use of solid-state catheter with higher fidelity in place of water-perfusion catheters, (c) use of circumferential in place of non-circumferential sensors, (d) facility to evaluate bolus transport by impedance monitoring that is available in most of the standard HRM devises, and (e) HRM is easier to perform than the conventional manometry. Display of the complex data using Clouse plot is a major advantage of HRM over conventional manometry. In the conventional manometry, the horizontal (X) axis depicts the time and the vertical (Y) axis represents the amplitude of contraction. In the Clouse plot of HRM, the horizontal (X) axis depicts the time, but the vertical (Y) axis represents the length of the esophagus. How to depict the amplitude of contraction then? Ray E Clouse decided to use different colors to represent the amplitude of contraction, the deep blue being the most negative pressure, and black showing highest positive pressure. Conventional manometry may miss esophageal motility disorders causing dysphagia. In a study on 250 patients with motor dysphagia, the cause could not be identified by conventional manometry in 15 % patients [8]. This might be due to widely spaced sensors in the catheter. Due to large number of sensors, HRM is expected to have higher fidelity to diagnose esophageal motility disorders, which has been documented in the literature [9]. One of the many advantages of the Clouse plot in HRM is the ease with which different esophageal motility disorders can be grossly recognized by the experienced motility doctors, but in the era of super-speciality health care using evidenced-based medicine and various mathematical scoring systems, are the doctors and patients happy with gross recognition of disorders?Chicago classification system has been developed by consensus among a group of motility experts based on the available evidence and general principles of esophageal physi...

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High-resolution Manometry: Esophageal Disorders Not Addressed by the "Chicago Classification"

Cited by 47 publications

References 44 publications

Intubation Failure During Gastroscopy: Incidence, Predictors and Follow-Up Findings

Intubation Failure During Gastroscopy: Incidence, Predictors and Follow-Up Findings

Манометрія В Дослідженні Рухової Функції Верхніх Відділів Травної Системи

Chicago classification of high-resolution esophageal manometry: Is old the gold or is new better?

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