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Assessing Bolus Retention in Achalasia Using High-Resolution Manometry With Impedance: A Comparator Study With Timed Barium Esophagram

2014; Lippincott Williams & Wilkins; Volume: 109; Issue: 6 Linguagem: Inglês

10.1038/ajg.2014.61

1572-0241

Yu K. Cho, Anna M. Lipowska, Frédéric Nicodème, Ezra N. Teitelbaum, Eric S. Hungness, Elyse Johnston, Andrew J. Gawron, Peter J. Kahrilas, John E. Pandolfino,

Esophageal and GI Pathology

OBJECTIVES: The aim of this study was to assess whether high-resolution impedance manometry (HRIM) could be used to assess bolus retention similar to the timed barium esophagram (TBE). METHODS: Twenty achalasia patients (10 males, aged 21–79 years) were prospectively evaluated with HRIM and TBE to determine the correlation between barium column height and the impedance bolus height (IBH). The TBE protocol used a 200-ml barium challenge and the HRIM protocol used a 200-ml saline challenge protocol. Both protocols were performed in an upright position and the heights of the barium and impedance columns were measured at 1 and 5 min. Analysis of IBH was performed with a topographic technique and a spatial impedance variation plot. RESULTS: There was no significant difference between the median IBH and barium column at 1 min (IBH: 12.0 cm (interquartile range (IQR), 8.0–18.0); TBE: 12.0 cm (IQR, 7.0–19.0);P=0.90) or at 5 min (IBH: 11.0 cm (IQR, 1.0–17.0); TBE: 9.0 cm (IQR, 4.0–12.0);P=0.47). In addition, the correlation between the two measurements at 1 and 5 min was 0.60 and 0.86, respectively. Using a barium column or impedance height of >5.0 as a definition of bolus retention was associated with 75% concordance at 1 min and 95% concordance at 5 min. CONCLUSIONS: There was excellent agreement between TBE and high-resolution impedance manometry (HRIM) for assessing bolus retention at 5 min. Thus, HRM with impedance may be used as a single test to assess bolus retention and motor function in the management of achalasia.