Division of Gastroenterology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8124, St Louis, MO 63110, USA.
Gut. 2012 Jun;61(6):798-803. doi: 10.1136/gutjnl-2011-301145. Epub 2011 Oct 13.
High resolution manometry (HRM) provides a colourful representation of oesophageal motility. Novice and intermediate learners were tested to compare HRM Clouse plots and conventional manometry for accuracy, ease of interpretation and knowledge retention.
36 learners evaluated 60 randomised motility sequences (30 HRM Clouse plots with corresponding line tracings) 4 months apart, following a tutorial. Learners rated prior knowledge of oesophageal pathophysiology and manometry and scored ease and speed of interpretation on 10 cm visual analogue scales (VAS).
Understanding of oesophageal pathophysiology was low in all cohorts (2.9±0.4 on VAS) and knowledge of HRM and conventional motility studies was even lower (1.9±0.4 and 1.8±0.3, respectively, p=NS). After the tutorial, diagnostic accuracy was significantly higher with HRM Clouse plots than with line tracings (p<0.001). HRM gains in diagnostic accuracy were evident over line tracings (43.1%), particularly with aperistalsis (36.1%), oesophageal body hypomotility (25.8%) and relaxation of the lower oesophageal sphincter (21.0%) (p<0.001 for each comparison); these were maintained at the second evaluation. Gains were independent of academic level (F=0.56, p=0.5) and did not correlate with prior experience of learners (r=-0.18, p=0.29). Learners favoured HRM Clouse plots (80.6%) over line tracings and reported faster interpretation (94.4%).
HRM Clouse plots provide ease of interpretation that translates into higher diagnostic accuracy and better knowledge retention in novice and intermediate learners of oesophageal manometry. These results implicate the value of pattern recognition in HRM interpretation, irrespective of academic level and prior understanding of oesophageal motor function.
高分辨率测压(HRM)提供了食管运动学的彩色图谱。本研究旨在测试新手和中级学习者对 HRM 克劳斯图和传统测压的准确性、解读的容易程度和知识保留程度。
36 名学习者在接受教程培训后,分别在 4 个月的时间内评估了 60 个随机的运动序列(30 个 HRM 克劳斯图和相应的线描图)。学习者根据 10cm 视觉模拟量表(VAS)评估他们对食管生理学和测压的先前知识,并对解读的容易程度和速度进行评分。
所有学习者对食管生理学的理解都很低(VAS 评分为 2.9±0.4),对 HRM 和传统运动研究的了解甚至更低(分别为 1.9±0.4 和 1.8±0.3,p=NS)。在接受教程培训后,HRM 克劳斯图的诊断准确性明显高于线描图(p<0.001)。与线描图相比,HRM 克劳斯图的诊断准确性明显提高(43.1%),尤其是在无蠕动(36.1%)、食管体蠕动减弱(25.8%)和下食管括约肌松弛(21.0%)(每种比较均为 p<0.001);这些在第二次评估中仍然存在。这些提高与学术水平无关(F=0.56,p=0.5),也与学习者的先前经验无关(r=-0.18,p=0.29)。学习者更喜欢 HRM 克劳斯图(80.6%)而不是线描图,并且报告解读速度更快(94.4%)。
HRM 克劳斯图提供了易于解读的优势,从而提高了新手和中级食管测压学习者的诊断准确性和更好的知识保留。这些结果表明,无论学术水平和对食管运动功能的先前理解如何,模式识别在 HRM 解读中都具有价值。