PWE-113 Comparing barium swallow with high resolution manometry in the diagnosis of primary oesophageal dysmotility – a retrospective study in a tertiary centre

Abstract

IntroductionThe gold standard for diagnosis of primary oesophageal dysmotility (POD) is high-resolution manometry (HRM). Barium swallow (BS) studies remain integral to many diagnostic algorithms for dysphagia. Our aim was to assess the sensitivity and specificity of BS in the diagnosis of POD including achalasia as defined using HRM.MethodPatients that had a BS and HRM within a year of each other over a period of 10 years were identified. Those with a history of upper gastrointestinal surgery were excluded. The HRM diagnosis was algorithmically deduced from the raw dataset using the appropriate Chicago classification1. All HRM diagnoses and barium term extractions were manually verified by the authors. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) and accuracy for BS were calculated for each of the positive BS terms identified. Subset analysis for achalasia specifically and all spasticity excluding achalaisa were performed.ResultsConclusionThis study suggests that BO patients with LGD have a high risk of developing HGD or Cancer. Furthermore, BO patients with ID have a low risk of progression. It is of paramount importance that patients diagnosed with LGD are intensively monitored through endoscopic surveillance or treated. ID patients should also be followed up but less frequently. This study highlighted that abnormal p53 expression detected through immunohistochemistry is a stronger predictor of malignant progression than LGD.Disclosure of InterestNone DeclaredAbstract PWE-113 Table 1Sensitivity and specificity for diagnosing all spasticity (i.e including DES, nutcracker, jackhammer, rapid contraction, hypertensive) EXCLUDING achalasia Barium swallow termSensitivitySpecificityNPVPPVAccuracyNo of positive BSNo of negative BSTPFPTNFN Tertiary6068.268.198.93.1941983911962Dysmotility091.289.798.10252670252625Spasm099.397.698.202290022855

Spectrum and Clinical Outcome of Motility Disorders on High-Resolution Esophageal Manometry: A Study From a Tertiary Center on Patients With Dysphagia in Pakistan

“…It is important to note that in 19.4% patients diagnosed with achalasia based on HRM findings, the barium study reported the presence of some other non-specific motility disorders. These findings were consistent with studies performed by El-Takli et al, in which the diagnosis of 42% patients with achalasia was missed by barium and by Schima et al, in which barium swallow correctly identified 58% of the cases diagnosed monometrically [4][5][6][7][8][9][10][11][12][13][14][15]. The low sensitivity of barium esophagram was attributed to the absence of the characteristic radiographic findings in most of the cases [4].…”

“…Barium swallow reveals a classic bird-beak appearance due to narrowing at the gastroesophageal (GE) junction and proximal dilation of the aperistaltic esophagus [ 4 ]. Recent studies have proven that high-resolution esophageal manometry (HRM) should be the diagnostic test of choice for primary esophageal dysmotility disorders [ 5 ].…”