Inter‐rater agreement of novel high‐resolution impedance manometry metrics: Bolus flow time and esophageal impedance integral ratio

Carlson, Dustin A.; Lin, Zhiyue; Kou, Wenjun; Pandolfino, John E.

doi:10.1111/nmo.13289

Cited by 20 publications

(25 citation statements)

References 13 publications

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“…8 Excellent inter-rater agreement [intra-class correlation coefficient (95% confidence interval) of 0.905 (0.875 – 0.928)] of EII-ratio calculation was recently demonstrated between two raters analyzing 200 swallows from patients with and without achalasia. 14…”

Section: Methodsmentioning

confidence: 99%

Improved Assessment of Bolus Clearance in Patients With Achalasia Using High-Resolution Impedance Manometry

Carlson

Beveridge

Lin

et al. 2018

Clinical Gastroenterology and Hepatology

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In a prospective study of 70 patients with achalasia, we found EII ratio identified patients with good PROs with higher levels of sensitivity (same specificity) than timed-barium esophagram or impedance-manometry bolus transit assessments. The EII ratio should be added to achalasia outcome evaluations that involve high-resolution impedance manometry as an independent measure and to complement timed-barium esophagram.

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Section: Methodsmentioning

confidence: 99%

Improved Assessment of Bolus Clearance in Patients With Achalasia Using High-Resolution Impedance Manometry

Carlson

Beveridge

Lin

et al. 2018

Clinical Gastroenterology and Hepatology

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“…The overall accuracy is higher than that of the timed barium esophagram. 73,74 Another important value of HRIM is the assessment of esophageal function before surgical fundoplication. Studies have shown that the pressure-flow index, a composite score of three AIM variables, predicts postoperative dysphagia in both adult and pediatric populations.…”

Section: Hrim For Esophageal Dysmotilitymentioning

confidence: 99%

Impedance in the evaluation of the esophagus

Sloan

Kuribayashi

et al. 2020

Annals of the New York Academy of Sciences

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The aim of this paper is to review esophageal electrical impedance technologies and to discuss the use of these technologies for physiological measurements, diagnostics, and therapy of esophageal disease. In order to develop a better understanding of the pathophysiology of and improve the diagnosis of esophageal disorders, such as gastroesophageal reflux disease (GERD) and achalasia, several new diagnostic tests, including intraluminal impedance, esophageal mucosal impedance, and the functional luminal imaging probe, have been developed. These technologies have proven valuable for assessment of the esophagus in recent years. They provide information on esophageal flow properties, mucosal integrity, lumen shape, and distensibility in esophageal disorders, in particular for GERD and achalasia. Despite their promise and novel clinical studies, the potential of these technologies has been far from realized. New multidisciplinary approaches will contribute to our understanding and interpretation of esophageal impedance data and disease mechanisms.

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“…Among these are the bolus flow time (BFT) and EII ratio, respectively, predicting flow across the esophagogastric junction (EGJ) or residual due to esophageal stasis as confirmed by studies using simultaneous videofluoroscopy . These advanced HRIM metrics can be reliably calculated as supported by generally excellent inter‐rater agreement . Both BFT and EII ratio have shown promising results in relation to symptom association over other manometric measures among NOD patients .…”

Section: Introductionmentioning

confidence: 96%

“…3,4 These advanced HRIM metrics can be reliably calculated as supported by generally excellent inter-rater agreement. 5 Both BFT and EII ratio have shown promising results in relation to symptom association over other manometric measures among NOD patients. 1,6 However, their application has not been studied in relation to a swallow-by-swallow bolus perception score for different bolus consistencies and volumes and analysis importantly excluded those patients with a HRM diagnosis of EGJ outflow obstruction (EGJOO).…”

Section: Introductionmentioning

confidence: 97%

High‐resolution impedance manometry parameters in the evaluation of esophageal function of non‐obstructive dysphagia patients

Singendonk

Lin

Scheerens

et al. 2018

Neurogastroenterology Motil

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Background High‐resolution impedance manometry (HRIM) allows evaluation of esophageal bolus retention, flow, and pressurization. We explored novel HRIM measures and assessed their temporal relationship to dysphagia symptoms for boluses of different volume and consistency in non‐obstructive dysphagia (NOD) patients. Methods Thirty‐three NOD patients (n = 19 minor or no disorder of peristalsis (“Normal”) and n = 14 esophagogastric junction outflow obstruction (“EGJOO”)) were evaluated with HRIM. Patients were administered 5 and 10 mL liquid, semisolid, and 2 and 4 cm solid boluses and indicated bolus perception during individual swallows using a 5‐point Likert scale. HRIM was analyzed to assess Chicago Classification and pressure flow metrics, esophageal impedance integral (EII) ratio, and bolus flow time (BFT). Key Results Overall, bolus perception increased with increasing bolus consistency (P < 0.001), but did not differ significantly between EGJOO and Normal patients. EGJOO patients had higher IRP4, higher levels of bolus residual (ie, EII ratio and IR), and restricted esophageal emptying. The results for linking semisolid bolus perception to semisolid‐derived measures revealed more biomechanically plausible and consistent patterns when compared to those derived for liquid boluses. In Normal patients, perception of boluses of heavier viscosity was related to higher bolus flow resistance during transport, whilst in EGJOO, perception was related to restriction of esophageal emptying. Conclusion & Inferences These novel pressure‐impedance measures may aid in the evaluation of NOD patients by revealing abnormal motor patterns, which may explain symptom generation. Future studies are needed to evaluate which of these measures are worthy of calculation and to establish protocol settings that allow for their meaningful interpretation.

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Inter‐rater agreement of novel high‐resolution impedance manometry metrics: Bolus flow time and esophageal impedance integral ratio

Abstract: The BFT and EII ratio can be reliably calculated as supported by generally excellent inter-rater agreement. Thus, broader utilization of these measures appears feasible and would facilitate further evaluation of their clinical utility.

Cited by 20 publications

References 13 publications

Improved Assessment of Bolus Clearance in Patients With Achalasia Using High-Resolution Impedance Manometry

Improved Assessment of Bolus Clearance in Patients With Achalasia Using High-Resolution Impedance Manometry

Impedance in the evaluation of the esophagus

High‐resolution impedance manometry parameters in the evaluation of esophageal function of non‐obstructive dysphagia patients

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