Detection of Incomplete Lower Esophageal Sphincter Relaxation With Conventional Point-Pressure Sensors

Staiano, Annamaria; Clouse, Ray E.
December 2001
American Journal of Gastroenterology;Dec2001, Vol. 96 Issue 12, p3258
Academic Journal
OBJECTIVE: Completeness of lower esophageal sphincter relaxation, a parameter used to establish the diagnosis of achalasia. is an important manometric determination. This study compared four analysis methods that use point-pressure measurements to determine their relative accuracy and the best threshold values for incomplete relaxation. METHODS: Analyses were performed on 153 manometric studies that employed a 21-lumen catheter with pressure recording sites spaced at 1-cm intervals. Lower sphincter relaxation was measured from most appropriate sites as the 1) lowest residual pressure within 5 s of swallowing, 2) lowest residual pressure across the entire postdeglutitive period, 3) lowest mean residual pressure over a floating 3-s interval after swallowing, and 4) mean transsphincteric esophagogastric gradient extracted from a combination of conventional and topographic manometric information. Intragastric baseline pressures were taken both from the pull-through maneuver and from concurrent intragastric recordings, and methods were compared by their receiver operating characteristics. RESULTS: Best threshold values for segregating achalasia from nonachalasic controls differed across methods and depended on presence or absence of peristalsis in the comparison group. Transsphincteric gradient measurement had high sensitivity (>0.94) and specificity (>:0.98) for achalasia irrespective of comparison group and was superior to all other methods. The 3-s mean residual pressure demonstrated greatest discriminant capabilities of the remaining conventional methods, which were modestly improved with concurrent measurement of intragastric pressure. CONCLUSIONS: Analyses that average postdeglutitive pressures are superior to isolated nadir values in correctly discerning incomplete lower sphincter relaxation. The trans-sphincteric gradient is a novel approach for measuring sphincter relaxation, is unaffected by sphincter asymmetry and...


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