Four-Dimensional Impedance Manometry in Esophageal Motility Disorders

• Published in: The American journal of gastroenterology Vol. 120; no. 5; pp. 1019 - 1026
• Main Authors: Goudie, Eric, Kou, Wenjun, Pandolfino, John E., Araujo, Isis K., Pitisuttithum, Panyavee, Halder, Sourav, Kahrilas, Peter J., Carlson, Dustin A.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Wolters Kluwer 01.05.2025; Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subjects: Adult; Aged; Asymptomatic; Biomechanics; Case-Control Studies; Catheters; Cross-sectional studies; Electric Impedance; Endoscopy; Esophageal Achalasia - diagnosis; Esophageal Achalasia - physiopathology; Esophageal Motility Disorders - diagnosis; Esophageal Motility Disorders - physiopathology; Esophagogastric Junction - diagnostic imaging; Esophagogastric Junction - physiopathology; Esophagus; Female; Humans; Male; Manometry - methods; Medical imaging; Middle Aged; Motility; Patients; Sensors; Software; Statistical analysis; intraluminal impedance; peristalsis; dysphagia; distensibility index; intrabolus pressure; esophageal motility
• ISSN: 0002-9270; 1572-0241; 1572-0241
• DOI: 10.14309/ajg.0000000000003151

INTRODUCTION:Four-dimensional high-resolution impedance manometry (4D HRM) uses impedance to estimate esophageal luminal cross-sectional area and track nadir impedance to measure intrabolus pressure (IBP). We aimed to determine whether 4D HRM metrics could define abnormal esophagogastric junction (EGJ) opening between Chicago Classification version 4.0 motility disorders and compare 4D HRM with functional lumen imaging probe (FLIP) metrics.METHODS:Symptomatic adult patients who completed high-resolution impedance manometry and FLIP were included and compared with an asymptomatic control group. 4D HRM analysis used custom-built software to measure IBP, maximum EGJ diameter, and distensibility index on supine test swallows. 4D HRM metrics were compared with FLIP EGJ metrics.RESULTS:Ninety patients (31 normal motility, 16 ineffective esophageal manometry, 9 absent contractility, 8 conclusive EGJ outflow obstruction [EGJOO], 12 type I achalasia, 14 type II achalasia, 12 type III achalasia, and 34 asymptomatic controls) were included. Phase 2 and 3 IBP was higher in type II and III achalasia compared with controls and normal motility groups (P < 0.03). Maximum EGJ diameter and EGJ-distensibility index in the conclusive EGJOO and achalasia groups were significantly lower than in controls and normal motility groups (P < 0.03). 4D HRM identified 37 of 44 (84%) subjects with normal EGJ opening and 29 of 39 (74%) subjects with reduced EGJ opening on FLIP.DISCUSSION:4D HRM metrics correlated with expected clinical observations across a spectrum of esophageal motility disorders and defined EGJ obstruction. 4D HRM metrics may have value in defining EGJ obstruction in equivocal cases related to EGJOO or absent peristalsis.