High-resolution manometry: Reliability of automated analysis of upper esophageal sphincter relaxation parameters

Abstract

Background/Aims: At present, automated analysis of high-resolution manometry (HRM) provides details of upper esophageal sphincter (UES) relaxation parameters. The aim of this study was to assess the accuracy of automatic analysis of UES relaxation parameters. Materials and Methods: One hundred and fifty three subjects (78 males, mean age 68.6 years, range 26-97) underwent HRM. UES relaxation parameters were interpreted twice, once visually (V) by two experts and once automatically (AS) using the ManoView ESO analysis software. Agreement between the two analysis methods was assessed using Bland-Altman plots and Lin's concordance correlation coefficient (CCC). Results: The agreement between V and AS analyses of basal UES pressure (CCC 0.996; 95% confidence interval (CI) 0.994-0.997) and residual UES pressure (CCC 0.918; 95% CI 0.895-0.936) was good to excellent. Agreement for time to UES relaxation nadir (CCC 0.208; 95% CI 0.068-0.339) and UES relaxation duration (CCC 0.286; 95% CI 0.148-0.413) between V and AS analyses was poor. There was moderate agreement for recovery time of UES relaxation (CCC 0.522; 95% CI 0.397-0.627) and peak pharyngeal pressure (CCC 0.695;) between V and AS analysis. Conclusion: AS analysis was unreliable, especially regarding the time variables of UES relaxation. Due to the difference in the clinical interpretation of pharyngoesophageal dysfunction between V and AS analysis, the use of visual analysis is justified.

Medical Diagnostic Tests: A Review of Test Anatomy, Phases, and Statistical Treatment of Data

“…Reporting the ICC and/or CCC along with associated 95% confidence intervals is good practice for agreement analysis. The results are reported in both primary (such as reliability analysis of the Microbleed Anatomical Rating Scale in the evaluation of microbleeds [143], automatic analysis of relaxation parameters of the upper esophageal sphincter [144], and the use of signal intensity weighted centroid in magnetic resonance images of patients with discs degeneration [145]) and secondary research studies (systematic review and/or meta-analysis: evaluation of the functional movement screen [146], evaluation of the Manchester triage scale on an emergency department [147], reliability of the specific physical examination tests for the diagnosis of shoulder pathologies [148], etc. ).…”

Expanding Instrumental Options for Dysphagia Diagnosis and Research: Ultrasound and Manometry

“…Currently, there are no commercially integrated platforms available for analysis of pharyngeal swallowing, with the exception of the UES [88]. Although there is ongoing work exploring classification models of pharyngeal swallowing similar to those used in oesophageal analysis [89], there is no consensus on optimal measurements of pharyngeal HRM.…”

“…Further, the optimal location for measurement of nadir UES pressure based on waveforms or topographical plots is currently unknown [92]. This finding was mirrored in a study investigating the reliability of an automated analysis of UES pressure [88], with a poor correlation found for UES relaxation duration (correlation coefficient = 0.29; 95% CI 0.15-0.41). These authors concluded that automated analysis of UES relaxation with HRM is similarly not accurate and called for development of novel analysis techniques.…”

“…Pharyngeal HRM is limited by a seldom-reported measurement error in the ManoScan™ system, used widely in research [52,73,81,82,88,92,93,94,95]. A pressure drift has been found to refute the manufacturer's report that pressure uniformity remains within 2 mm Hg for 4 h or less of recording [93,96].…”

“…With a possible pressure drift of 6.5 mm Hg in 15 min, caution is needed when interpreting acquired data and forming subsequent diagnoses. While the manufacturer recommends applying TC to all studies prior to analysis, use of TC has only been reported in one paper [88], and the possibility of measurement error and use of standard correction methods was not mentioned in the published clinical protocol for execution of pharyngeal HRM [52]. This is critical, as it is unclear which results may be affected by measurement error, since overall pressure drift can have a substantial impact in clinical diagnosis and research of pharyngeal and oesophageal function.…”