Interobserver variability in antroduodenal manometry

Abstract

Interobserver variability affects investigations involving assessment of complex visual data, such as histopathology, radiology and motility. This study assessed interobserver variation for interpretation of antroduodenal manometry (ADM), as this has not been previously investigated. Thirty-five ADM recordings from children aged 0.3-18 years were independently evaluated by five experienced paediatric gastroenterologists who were blinded to cases' clinical histories. Intra-class correlation (ICC) was analysed for detection and measurement of phase three of the migrating motor complex (MMC) and Cohen's kappa statistic was calculated between observer pairs for detection of specific motility features and final diagnosis. Observers were unanimous on the differentiation of normal and abnormal motility in 63% of cases. There was excellent interobserver agreement for the number of phase three of the MMC in fasting (ICC = 0.82, P < 0.0001) and for measurements of phase three of the MMC (ICC = 0.9999, P < 0.0001). Detection of other normal and abnormal motility patterns varied more. Objective findings such as the presence of phase three of the MMC correlated more closely than findings that involved the integration of several variables, such as final diagnosis. However, these data overall indicate that agreement between expert observers for the distinction of normal and abnormal antroduodenal motility compares favourably with other standard medical assessments.

Colon High‐Resolution Manometry

“…In the present study, observer 2 showed 60% agreement regarding GCR and overall study interpretation, suggesting the main cause for suboptimal overall study interpretation was variability in interpreting the GCR instead of the manner in which the data were displayed. Problems in evaluating the meal response on bowel motility are not limited to the colon manometry; Connor et al reported a greater variability in evaluating postprandial hypomotility for antroduodenal manometry testing in children (12). Although the kappa statistic is commonly used to assess reliability, caution is required when interpreting the magnitude of the kappa statistic because it is influenced by the prevalence of the rating (if the prevalence is high, chance agreement is also high and kappa is reduced accordingly) and by the bias (when there is a large bias, kappa is higher).…”

An ANMS‐NASPGHAN consensus document on esophageal and antroduodenal manometry in children

“…Typically, acid suppression is continued unless the patient is more likely to experience symptoms during testing off therapy thus providing greater insight into the pathophysiology of symptoms. 6,7,11,13 While other medications may have an effect on motility (e.g baclofen, antipsychotic medications, attention deficit medications), stopping them prior to testing may not medically feasible. Similarly, while vagal nerve stimulators may have an impact on esophageal motility, the risk/benefit analysis for turning off the stimulator must be considered.…”

“…It has contributed to the understanding of the pathophysiology of neuromuscular disorders of the stomach and small bowel by assessing pressure amplitude and coordination. 6,7,10,11 In most institutions, ADM is still performed using traditional perfused catheters (Figures 2 and 3) though high resolution catheters are now available (Figures 2 and 3). 8…”

“…6,7 A normal motility pattern is defined as: (viii) inability to establish a fed pattern ( Figure 6); and (ix) presence of phase III like activity during the fed period if appropriate calories were administered. 6,7,11,38,41,66,70 Because 1/3 to ½ of the phase III activity can commence distal to the stomach, the absence of the antral component of phase III is not necessarily abnormal. 6,76 Other abnormal contractions patterns that can be seen include: (i) discrete clustered contractions (DCC) composed of 3 to 10 pressure waves of slow frequency, that propagate aborally at a rate of 1-2 cm/s usually through 30-40 cm ( Figure 4); 77 (ii) bursts of contractions that can be short or sustained, the latter of which is abnormal; 77 (iii) the simultaneous increases in pressure throughout all the recording sensors (R wave), usually associated with regurgitation or frank emesis, that represent the manometry correlate of rumination syndrome.…”

Established and emerging methods for assessment of small and large intestinal motility

“…Inter-observer agreement for normal vs abnormal antroduodenal motility compares well with other diagnostic tests, and specific patterns may suggest disease in both children and adults. 11 Clinical indications include diagnostic clarification of slow gastric or small bowel transit (neuropathy or myopathy), unexplained abdominal pain, and nausea/vomiting. 12 Pitfalls include confounding by cough or movement, displacement of the catheter in the antrum/duodenum, and common manometric features among several dysmotility syndromes.…”