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Diagnostic performance of endoscopic pressure study integrated system (EPSIS): A novel diagnostic tool for gastroesophageal reflux disease
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Yuto Shimamura1,
Masaki Ominami2,
Haruhiro Inoue1 |
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1Digestive Diseases Center, Showa University Koto Toyosu Hospital, 2Department of Gastroenterology, Osaka City University |
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| Background and aims: Endoscopic pressure study integrated system (EPSIS) has been recently developed to allow for endoscopic evaluation of lower esophageal sphincter function. The aim of this study was to evaluate the utility and performance of this novel system in the diagnosis of GERD. Methods: A retrospective study from 59 patients (mean age 54±16 years; 30 men) who underwent both EPSIS and 24-hour pH monitoring from April 2016 to March 2018 was conducted. Patients on PPIs at the time of the examinations were excluded. EPSIS was performed as follows: 1) routine gastroscopy; 2) observation of gastroesophageal junction in retroflex view; and 3) measurement of intragastric pressure (IGP) by using through-the-scope catheter connected to the pressure measuring instrument. The maximum IGP and waveform pattern of IGP (uphill or flat) were recorded. Results: The additional time required was less than 5 minutes. Both maximum IGP<20mmHg and flat waveform pattern significantly correlated with DeMeester score>14.72 (P=0.03) and the number of acid reflux episodes (P=0.01). Thirty-two patients (54.2%) were diagnosed positive for GERD based on pH monitoring. Forty patients (67.8%) were considered positive with either maximum IGP<20mmHg or flat waveform pattern on EPSIS. Sensitivity, specificity, overall accuracy of positive EPSIS findings were 81.3% (95% CI, 65.6-92.8), 48.2% (95% CI, 28.7-68.9), 66.1% (95% CI, 52.6-77.9), respectively in the diagnosis of GERD by pH monitoring. Conclusion: EPSIS may serve as a fast and reliable adjunct to regular gastroscopy for the assessment of GERD probability, thus identifying the subgroup of patients that ultimately require further testing. |
Index Term 1: Esophagus
Index Term 2: Gastroesophageal reflux disease |
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