Association between endoscopic pressure study integrated system (EPSIS) and high-resolution manometry in patients with gastroesophageal reflux disease

Background and aims
EPSIS is a diagnostic tool for GERD which allows monitoring the intragastric pressure during upper endoscopy to evaluate the anti-reflux function. The study aim was to assess the correlation between EPSIS results and the LES pressure measured by high-resolution manometry (HRM).
Methods
A retrospective analysis was conducted of data prospectively collected over a 2-year period from 47 patients who underwent EPSIS and HRM for GERD symptoms. Using a dedicated intragastric pressure measuring device, pressure difference and the pressure gradient of the waveform were recorded. According to the results from previous study (Characterization of intragastric pressure waveform in EPSIS: a novel diagnostic device for gastroesophageal reflux disease. Dig Endosc 2020), EPSIS results were divided into two patterns. Pressure difference≥4.7 mmHg and the pressure gradient≥0.07 mmHg/s were defined as “EPSIS normal pattern” or otherwise defined as “EPSIS GERD pattern”.
Results
Thirty-seven patients (78.7%) were diagnosed with “EPSIS normal pattern”. Patients with “EPSIS GERD pattern” showed lower basal LES pressure (14.0 vs 26.1 mmHg, p=0.004), lower end-respiratory LES pressure (9.1 vs 17.1 mmHg, p=0.023) and lower IRP (6.0 vs 9.7 mmHg, p=0.015) [mean±SD] measured by HRM.
Conclusions
EPSIS is closely associated to the LES pressure measured by HRM, and it enables us to evaluate the function of LES endoscopically.