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Endoscopic impedance planimetry versus high-resolution manometry (HRM) for pre-operative motility evaluation in anti-reflux surgery

  • 2023 SAGES Oral
  • Published:
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Abstract

Introduction

Pre-operative evaluation of patients with gastroesophageal reflux disease (GERD) includes assessment of esophageal motility. High-resolution manometry (HRM) is the gold standard; endoscopic impedance planimetry (IP) with Endoflip 2.0 is increasingly utilized in esophageal disorders of motility. We hypothesized that normal IP motility would correlate with normal HRM motility and tested this in a prospective cohort study.

Methods

Patients presenting for surgical evaluation of GERD between 9/2020 and 10/2021 were prospectively enrolled under an IRB-approved protocol. Patients with prior esophageal/gastric surgery, known motility disorders, or large paraesophageal hernias were excluded. All underwent HRM and IP, with normal motility defined by Chicago 3.0 classification for HRM and the presence of repetitive antegrade contractions for IP. Logistic regression and t test were used to analyze the data; p value < 0.05 was considered significant.

Results

Of 63 patients enrolled, 48 completed both IP and HRM testing. The cohort was 50% male with a median age of 52.5 [42.0, 66.0] years, mostly ASA class 1–2 (75.1%, n = 36) and had an average BMI of 31.4 ± 6.3 kg/m2. Normal motility tracings were in 62.5% of IP and 75% of HRM tests. Using HRM as the gold standard, IP detected normal motility with a sensitivity of 65.8% and a specificity of 50% (positive predictive value 83.3%, negative predictive value 27.8%). Normal IP was not statistically significant in predicting normal HRM (OR 3.182, 95% CI 0.826–12.262, p = 0.0926). Tolerability of IP was significantly better than HRM with lower rates of discomfort (10.9% vs. 93.4%, p < 0.0001) and higher willingness to repeat testing (100% vs. 47.8%, p < 0.0001).

Conclusion

Esophageal motility testing with Endoflip 2.0 is well tolerated by patients. The low specificity (50%), poor negative predictive value (27.8%), and lack of statistically significant concordance between IP and HRM raises concern for the reliability of this test as a stand-alone replacement for HRM in the pre-operative evaluation for GERD.

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Acknowledgements

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Funding

Funding was provided by Society of American Gastrointestinal Surgeons (SAGES) 2020 Grant.

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Authors and Affiliations

  1. Department of Surgery, Center for Minimally Invasive Surgery, The Ohio State University, Columbus, OH, USA

    Theresa N. Wang, Jennifer Underhill, Kyle A. Perry & Kelly R. Haisley

  2. Department of Surgery, Center for Surgical Health Assessment, Research and Policy, The Ohio State University, Columbus, OH, USA

    Robert Tamer

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Correspondence to Theresa N. Wang.

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Theresa Wang, Jennifer Underhill, Robert Tamer, Kyle Perry, and Kelly Haisley have no conflicts of interest or financial ties to disclose.

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Meeting Presentation: SAGES 2023—Montreal, Canada.

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Wang, T.N., Underhill, J., Tamer, R. et al. Endoscopic impedance planimetry versus high-resolution manometry (HRM) for pre-operative motility evaluation in anti-reflux surgery. Surg Endosc 38, 377–383 (2024). https://doi.org/10.1007/s00464-023-10418-x

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