Original articlesEsophageal manometry: Assessment of interpreter consistency
Section snippets
Study design
A total of 72 esophageal manometry tracings were selected from the archives of the Center for Swallowing and Esophageal Disorders at the Cleveland Clinic Foundation between 2000 and 2003. At our institution, well over 1000 archived recordings are stored electronically by diagnosis. An equal number of recordings for each diagnosis were selected randomly and categorized as follows: normal, nutcracker esophagus, hypertensive LES, hypotensive LES, DES, IEM, and achalasia according to generally
Results
Table 2 lists patient demographics for the 7 manometric diagnoses. Overall, the mean (±SD) age of patients was 52 years (±13 y; range, 25–81 y), and 29 patients (40%) were men. Patients with a normal manometry diagnosis tended to be younger (mean age, 47 y), whereas those with nutcracker esophagus were older (mean age, 60 y) than others. The most common presenting symptoms before manometry were heartburn and regurgitation (37%), dysphagia (33%), chest pain (25%), and chronic cough (5%). The
Discussion
This study was a prospective, multi-interpreter, randomized, blinded study assessing the reliability of esophageal manometry interpretations. We found a strong intra- and interobserver agreement in diagnosing the 2 extremes in the spectrum of motility diagnoses, normal and achalasia, with a κ score of .63 and .68, respectively. However, despite the level of expertise, interpretation of other esophageal motility disorders have poor interobserver agreement, with a κ score .27 (Table 5). We found
References (11)
- et al.
American Gastroenterological Association position statement and technical review on the clinical use of esophageal manometry
Gastroenterology
(1994) Oesophageal motility disorders
Lancet
(2001)- et al.
Sphincter of Oddi manometryinterobserver variability
Gastrointest Endosc
(1993) - et al.
Abnormal esophageal motility. An analysis of concurrent radiographic and manometric findings
Gastroenterology
(1991) - et al.
Application of topographical methods to clinical esophageal manometry
Am J Gastroenterol
(2000)
Cited by (53)
Practice guidelines on the use of esophageal manometry – A GISMAD-SIGE-AIGO medical position statement
2016, Digestive and Liver DiseaseCitation Excerpt :Further, in case of simultaneous contraction in more than 1 swallow we have a diffuse esophageal spasm. This classification is simple; however, even for experienced physiologists in tertiary centers, inter-observer agreement in the interpretation of manometric measurements is poor [36]. The enhanced pressure resolution and the objective metrics of esophageal function are immediately available with HRM/EPT and can be applied to classify individual swallows and generate an esophageal motility diagnosis.
Medical treatment versus surgery for treatment of gastroesophageal reflux disease
2015, Techniques in Gastrointestinal EndoscopyCitation Excerpt :Abnormalities can stem from any or all components of the system and ultimately contribute to the pathogenesis of GERD and its sequelae. The effect of esophageal dysfunction [8] and resultant damage to pre-epithelial [8,9], epithelial [8], and postepithelial [8] defense mechanisms; LES dysfunction [10]; abnormal LES pressures [11-15]; and structural abnormalities (eg, hiatal hernia) [16-18] has been well demonstrated in the pathogenesis of GERD. Emerging data have shifted focus on to the role of transient LES relaxations (TLESR) and the acid pocket as a potential underlying mechanism in the pathogenesis of GERD.
Motility Disorders of the Esophagus
2014, Textbook of Gastrointestinal Radiology: Volumes 1-2, Fourth EditionBotulinum Toxin in Nonachalasia Motility Disorders: A Welcomed Therapy in an Area With Limited Therapeutic Options
2013, Clinical Gastroenterology and HepatologyA Comparison of Symptom Severity and Bolus Retention With Chicago Classification Esophageal Pressure Topography Metrics in Patients With Achalasia
2013, Clinical Gastroenterology and HepatologyCitation Excerpt :In addition, bolus retention on TBE is a useful metric in assessing treatment outcome in that it can substantiate the necessity for further treatment.2,4–6 On the other hand, although most clinical guidelines advise that the diagnosis of achalasia requires manometric evaluation, some suggest that manometry is not required in post-treatment management.8,15 Although an EGJ pressure of less than 10 mm Hg after treatment has been identified as indicative of good outcome, there are conflicting reports regarding the utility of this measurement in the evaluation of post-treatment success.13,16,17
Esophageal function testing
2012, Gastrointestinal EndoscopyCitation Excerpt :The optimal performance of manometry requires accurate data acquisition and interpretation. In 1 study in which conventional manometry was used, interobserver agreement for the extremes of motility diagnoses (eg, normal and achalasia) was good at all levels of experience (κ = 0.66-0.71).10 However, for other motility disorders (eg, nutcracker esophagus, hypertensive and hypotensive LES, diffuse esophageal spasm), interobserver agreement was poor, even among experienced providers (κ = 0.35).