Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
Institute of Digestive and Liver Diseases, St. Luke's Medical Center, Quezon City, Philippines.
Dig Endosc. 2024 May;36(5):565-572. doi: 10.1111/den.14695. Epub 2023 Oct 20.
The endoscopic pressure study integrated system (EPSIS) is a novel diagnostic tool used to evaluate lower esophageal sphincter (LES) function. EPSIS allows the measurement of intragastric pressure (IGP) during gastric insufflation through esophagogastroduodenoscopy (EGD) and records its pressure waveform. This study aimed to assess the usefulness and applicability of EPSIS as an adjunct diagnostic modality for achalasia.
This case-control study was conducted using a database of patients who underwent EGD, barium swallow (BS), high-resolution manometry (HRM), and EPSIS between January 2022 and December 2022. The achalasia (experimental) group (n = 35) consisted of patients with a definitive diagnosis of achalasia. The control group (n = 34) consisted of patients with no abnormalities in EGD, BS, or HRM and no abnormal acid reflux confirmed with 24-h pH-impedance monitoring. EPSIS findings were compared between the two groups and characterized by the waveform pattern (uphill or flat), maximum IGP (IGP-Max), pressure difference, and the gradient of the waveform.
All patients in the achalasia group showed an uphill pattern, in contrast to 21 patients (61.8%) in the control group. IGP-Max demonstrated the best diagnostic accuracy for achalasia, with a cut-off value of 15.8 mmHg (100% sensitivity, 58.8% specificity, and area under the curve [AUC] 0.78). The pressure gradient also demonstrated good diagnostic accuracy, with a cut-off value of 0.40 mmHg/s (80% sensitivity, 61.8% specificity, and AUC 0.76).
This study demonstrated that EPSIS can be applied as a diagnostic modality in patients with achalasia.
内镜压力研究综合系统（EPSIS）是一种用于评估下食管括约肌（LES）功能的新型诊断工具。EPSIS 允许通过食管胃十二指肠镜检查（EGD）在胃充气时测量胃内压（IGP），并记录其压力波形。本研究旨在评估 EPSIS 作为贲门失弛缓症辅助诊断方法的有用性和适用性。
本病例对照研究使用了 2022 年 1 月至 2022 年 12 月期间接受 EGD、钡餐（BS）、高分辨率测压（HRM）和 EPSIS 的患者数据库。贲门失弛缓症（实验组）（n=35）组由确诊为贲门失弛缓症的患者组成。对照组（n=34）由 EGD、BS 或 HRM 无异常且 24 小时 pH 阻抗监测未证实异常酸反流的患者组成。比较两组之间的 EPSIS 发现，并通过波形模式（上坡或平坦）、最大 IGP（IGP-Max）、压力差和波形梯度进行特征描述。
所有贲门失弛缓症组患者均表现为上坡模式，而对照组中有 21 例（61.8%）患者表现为上坡模式。IGP-Max 对贲门失弛缓症具有最佳的诊断准确性，截断值为 15.8mmHg（100%敏感性、58.8%特异性和曲线下面积 [AUC]0.78）。压力梯度也具有良好的诊断准确性，截断值为 0.40mmHg/s（80%敏感性、61.8%特异性和 AUC0.76）。
本研究表明，EPSIS 可作为贲门失弛缓症患者的一种诊断方法。
