High-Resolution Pharyngeal Manometry and Impedance: Protocols and Metrics—Recommendations of a High-Resolution Pharyngeal Manometry International Working Group

Omari, Taher; Ciucci, Michelle R.; Gozdzikowska, Kristin; Hernandez, Esther Guiu; Hutcheson, Katherine A.; Jones, Corinne A.; Maclean, Julia; Nativ‐Zeltzer, Nogah; Plowman, Emily K.; Rogus-Pulia, Nicole; Rommel, Nathalie; O’Rourke, Ashli

doi:10.1007/s00455-019-10023-y

Cited by 83 publications

(117 citation statements)

References 99 publications

Supporting

Mentioning

113

Contrasting

Order By: Relevance

“…Pharyngoesophageal junction motility during swallowing is traditionally difficult to explore, even using the most recent technology, including videofluoroscopy and HRM coupled with intraluminal impedance recording manometry. This relies on the lack of reliable objective measures and/or limited interrater reliability to assess upper esophageal sphincter resting pressure and opening 65,66 . The recent development of FLIP measurement provided a new tool to assess dynamic change of pharyngoesophageal junction geometry and distensibility, especially during swallowing.…”

Section: Resultsmentioning

confidence: 99%

The use of impedance planimetry (Endoscopic Functional Lumen Imaging Probe, EndoFLIP^®) in the gastrointestinal tract: A systematic review

Desprez

Roman

Leroi

et al. 2020

Neurogastroenterology Motil

View full text Add to dashboard Cite

Background and purpose The EndoFLIP® system is a method of delineating impedance and was first designed to investigate the characteristics of the esophago‐gastric junction. In the last decade, its use was widened to investigate other sphincteric and non‐sphincteric systems of the gastrointestinal tract. The objective of the present systematic review was to summarize the available data in literature on the use of the EndoFLIP® system in the gastrointestinal tract, including sphincteric and non‐sphincteric regions. We performed a systematic review in accordance with recommendations for systematic review using PRISMA guidelines without date restriction, until June 2020, using MEDLINE‐PubMed, Cochrane Library, and Google Scholar databases. Only articles written in English were included in the present review. Five hundred and six unique citations were identified from all database combined. Of those, 95 met the inclusion criteria. There was a lack of standardization among studies in terms of anesthetic drugs use, probe placement, and inflation protocol. In most cases, only small cohorts of patients were included. Most studies investigated the EGJ, with a potential use of the EndoFLIP® to identify a subgroup of patients with achalasia and for intraoperative assessment of treatment efficacy in achalasia. However, the use of EndoFLIP® in the esophageal body (esophageal panometry), other esophageal diseases (gastro‐esophageal reflux disease, eosinophilic esophagitis), and other sphincter regions (anal canal, pylorus) will need further confirmatory studies. The EndoFLIP® system provides detailed geometric data of the gastrointestinal lumen but further works are needed to determine its use in clinical practice.

show abstract

Section: Resultsmentioning

confidence: 99%

The use of impedance planimetry (Endoscopic Functional Lumen Imaging Probe, EndoFLIP^®) in the gastrointestinal tract: A systematic review

Desprez

Roman

Leroi

et al. 2020

Neurogastroenterology Motil

View full text Add to dashboard Cite

show abstract

“…It was interesting to note that, unlike velopharyngeal and mesopharyngeal contractile integrals, hypopharyngeal contractile integral (HPCI) was not altered by any form of sensory stimulation in this study. It has been suggested that epiglottic inversion during swallowing can alter HPCI measures (4). Additionally, contractile integrals or pressure changes over space and time may not be as pertinent to the hypopharyngeal phase of swallowing compared to the velopharyngeal and mesopharyngeal stages.…”

Section: Discussionmentioning

confidence: 99%

“…It could be possible that the method for calculating this metric could be influencing this finding (see Table 1). Use of maximum admittance based on impedance measures would be worthy of investigation in future research (4). No previous research was found evaluating the effect of cold on either duration or extent of UES opening as outcomes from previous research related to swallow safety, pharyngeal response time and pharyngeal retention (28).…”

Section: Discussionmentioning

confidence: 99%

“…Pressure-flow data has been used to create useful algorithms and classification models which have been found to predict aspiration status and pharyngeal residue during VFS (2,3). An international PHRM working group recently established consensus on PHRIM methodology, protocol and outcome metrics to guide international research and practice (4).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of Sensory Stimulation on Pharyngo-esophageal Swallowing Biomechanics in Adults with Dysphagia: A High-Resolution Manometry Study

Regan

2020

Dysphagia

View full text Add to dashboard Cite

Evidence supporting sensory stimulation of swallowing is based mostly on videofluoroscopy and provides little insight into changes to swallowing physiology. In this study, the impact of sensory stimulation on pharyngo-esophageal swallowing biomechanics was investigated in adults with dysphagia using pharyngeal high resolution manometry. Method(s): Fifteen adults (8 males; 45-86 years) with mixed etiology dysphagia were consecutively recruited over a three-month period. PHRM equipment with a 4.2mm pressure catheter was used. The protocol included duplicate 10ml neutral, sour, cold and carbonated liquid swallows in randomized order. Semi-automated analysis was completed using an online portal (www.swallowgateway.com). Result(s): Data from 98/120 swallows were analyzed. During the pharyngeal phase, mean pharyngeal contractile integral (PhCI) increased significantly with cold (p=0.03), sour (p=0.00) and carbonation (p=0.02). Mean velopharyngeal contractile integral (VCI) (p=0.01) and mesopharyngeal contractile integral (MCI) (p=0.04) both increased significantly with carbonation. Mean hypopharyngeal contractile integral (HPCI) was not significantly altered by sensory stimulation. Regarding UES opening, UES relaxation time (UESRT) increased significantly with cold (p=0.032), carbonation (p=0.032), and sour (p=0.027). Extent of UES opening as measured by IRP reduced significantly with cold stimulation (9.34 to 5.17mmHg) (p=0.032). No significant changes were observed to UES basal pressure or UES peak pressure with sensory stimulation. Conclusions: Sensory stimulation induced biomechanical changes to pharyngeal contraction vigor, UES relaxation time and extent of UES opening during swallowing in adults with dysphagia. This study contributes evidence to support sensory stimulation as a dysphagia intervention. Further combined pressure impedance studies in homogeneous clinical populations are ongoing.

show abstract

“…CC v3.0 assesses three key manometric parameters looking at Phases 3‐4 of esophageal bolus transit: (a) integrated relaxation pressure (IRP) measuring the post‐deglutition EGJ relaxation; and (b) distal contractile integral (DCI) assessing the amplitude and duration of esophageal contractions, and (c) distal latency (DL) assessing the smooth muscle contractility in the mid‐ and distal esophagus 5 . Some studies suggest that impairment of UES relaxation (Phase 1 of esophageal transit) is a risk factor for aspiration in patients with dysphagia, and the High‐Resolution Pharyngeal Manometry International Working Group recently standardized UES measurements and reporting 6,7 . There is paucity of data on the proximal esophageal striated muscle contractility or Phase 2 of esophageal bolus transit in patients with symptoms of esophageal motility disorders.…”

Section: Introductionmentioning

confidence: 99%

Characterizing the proximal esophageal segment in patients with symptoms of esophageal dysmotility

Jehangir

Tanner

Malik

et al. 2020

Neurogastroenterology Motil

View full text Add to dashboard Cite

Background Proximal esophageal striated muscle contractility may be abnormal in patients with esophageal symptoms, but is not assessed in the Chicago Classification (CC) v3.0. We aimed to (a) determine the prevalence of abnormal proximal esophageal contractility in patients with esophageal symptoms; (b) compare proximal esophageal contractility in patients with different esophageal motility disorders; (c) assess the association of abnormal proximal esophageal contractility with esophageal symptoms. Methods Patients undergoing high‐resolution esophageal manometry (HREM) from 7/2019 to 11/2019 and healthy volunteers (HVs) were studied. Measurements of the proximal esophageal segment included the vigor of contractility of the proximal esophagus (proximal contractile integral/PCI). Patients rated gastrointestinal symptoms’ severity. Key Results HREM was performed on 221 patients (63.8% females, mean age 57.1 ± 1.1 years) and 19 HVs. Mean PCI in HVs was 299.5 ± 30.6 (95% CI 32.3‐566.7 mm Hg.s.cm). Of all patients, 61 (27.6%) had abnormal PCI. HVs and patients with different esophageal motility disorders had significantly different PCI (P < .01). Type 1 achalasia patients had weaker PCI than patients with absent contractility (P = .02). Patients with abnormal PCI had more severe dysphagia (P = .02), nausea (P = .03), vomiting (P = .03), and lower bolus clearance (P < .01) than patients with normal PCI. Conclusions and Inferences Abnormal PCI was found in a fourth of patients with esophageal symptoms. PCI may be useful to distinguish some esophageal motility disorders. Patients with abnormal PCI had a higher severity of some upper gastrointestinal symptoms than patients with normal PCI. Assessing the proximal esophageal segment on HREM may be useful in characterizing patients with esophageal symptoms.

show abstract

High-Resolution Pharyngeal Manometry and Impedance: Protocols and Metrics—Recommendations of a High-Resolution Pharyngeal Manometry International Working Group

Cited by 83 publications

References 99 publications

The use of impedance planimetry (Endoscopic Functional Lumen Imaging Probe, EndoFLIP^®) in the gastrointestinal tract: A systematic review

The use of impedance planimetry (Endoscopic Functional Lumen Imaging Probe, EndoFLIP^®) in the gastrointestinal tract: A systematic review

Impact of Sensory Stimulation on Pharyngo-esophageal Swallowing Biomechanics in Adults with Dysphagia: A High-Resolution Manometry Study

Characterizing the proximal esophageal segment in patients with symptoms of esophageal dysmotility

Contact Info

Product

Resources

About

High-Resolution Pharyngeal Manometry and Impedance: Protocols and Metrics—Recommendations of a High-Resolution Pharyngeal Manometry International Working Group

Cited by 83 publications

References 99 publications

The use of impedance planimetry (Endoscopic Functional Lumen Imaging Probe, EndoFLIP®) in the gastrointestinal tract: A systematic review

The use of impedance planimetry (Endoscopic Functional Lumen Imaging Probe, EndoFLIP®) in the gastrointestinal tract: A systematic review

Impact of Sensory Stimulation on Pharyngo-esophageal Swallowing Biomechanics in Adults with Dysphagia: A High-Resolution Manometry Study

Characterizing the proximal esophageal segment in patients with symptoms of esophageal dysmotility

Contact Info

Product

Resources

About

The use of impedance planimetry (Endoscopic Functional Lumen Imaging Probe, EndoFLIP^®) in the gastrointestinal tract: A systematic review

The use of impedance planimetry (Endoscopic Functional Lumen Imaging Probe, EndoFLIP^®) in the gastrointestinal tract: A systematic review