Improved esophagography screening for esophageal motility disorders using wave appearance and supra-junctional ballooning
Improved esophagography screening for esophageal motility disorders using wave appearance and supra-junctional ballooning
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DOI：
10.1007/s00535-022-01913-4
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发表时间：
2022-08-24
影响因子：
6.3
通讯作者：
Ogawa，Yoshihiro
中科院分区：
文献类型：
--
作者：
Hata，Yoshitaka;Ihara，Eikichi;Ogawa，Yoshihiro
背景高分辨率测压（HRM）是诊断食管动力障碍（EMD）的金标准，但它需要专门的设备。预计将开发更方便的筛查方法。我们评估了钡剂食管造影（BE）筛查的实用性，使用两种新的发现来诊断EMDs.MethodsBetween 2013年1月和2020年10月，244例疑似EMD患者进行了HRM和BE进行了分析。EMD诊断基于HRM结果，使用芝加哥分类3.0版。使用硫酸钡连续食管造影进行BE。三种常规BE结果（气液平面、玫瑰珠状/螺旋状外观和无/弱水肿）和两个新的BE发现结果用这两种新的表现和常规表现进行BE筛查诊断EMD的敏感性和特异性分别为79.4%和88%，受试者工作特征曲线下面积（AUC）= 0.837。在没有这些新发现的情况下，它们分别为63.9%和96%（AUC = 0.800）。贲门失弛缓症与气液平面高度相关（88.7%）。收缩力缺失与蠕动缺失/微弱高度相关（85.7%）。食管远端痉挛与玫瑰珠状/螺旋状外观（60%），贲门失弛缓症与波形外观（59.7%）之间存在相对较高的相关性。个体BE结果的观察者内重现性和观察者间一致性分别为84.4%和75%。波的出现与较高的综合松弛压（IRP）和较短的远端潜伏期。交界处气球样变与较高的IRP.ConclusionsBE筛查使用两个额外的新的发现，诊断EMD可能是有用的，在一般的做法。
BackgroundHigh-resolution manometry (HRM) is the gold standard for diagnosing esophageal motility disorders (EMDs); however, it requires specialized equipment. The development of more accessible screening examinations is expected. We evaluated the utility of barium esophagography (BE) screening using two novel findings to diagnose EMDs.MethodsBetween January 2013 and October 2020, 244 patients with suspected EMDs who underwent both HRM and BE were analyzed. The EMD diagnosis was based on HRM findings using Chicago Classification version 3.0. BE was performed using sequential esophagography with barium sulfate. Three conventional BE findings (air-fluid level, rosary-bead/corkscrew appearance, and absent/weak peristalsis) and two novel BE findings (wave appearance and supra-junctional ballooning) were used for diagnosis.ResultsThe sensitivity and specificity of BE screening using the two novel findings and conventional findings to diagnose EMDs were 79.4% and 88%, respectively [area under the receiver-operating characteristic curve (AUC) = 0.837]. Without these novel findings, they were 63.9% and 96%, respectively (AUC = 0.800), respectively. Achalasia was highly correlated with the air-fluid level (88.7%). Absent contractility was highly correlated with absent/weak peristalsis (85.7%). Relatively high correlations were observed between distal esophageal spasm and rosary-bead/corkscrew appearance (60%), and between achalasia and wave appearance (59.7%). The intra-observer reproducibility and inter-observer agreement for individual BE findings were 84.4% and 75%, respectively. Wave appearance was associated with higher integrated relaxation pressure (IRP) and shorter distal latency. Supra-junctional ballooning was associated with higher IRP.ConclusionsBE screening using two additional novel findings to diagnose EMDs could be useful in general practice.