301: Ineffective Esophageal Motility: The Impact of Change of Criteria in Chicago Classification Version 4.0 (CCV4.0) on Predicting Surgical Outcome

Riccardi, Margaret; Tamesis, Steven; Zheng, Ping; Eriksson, Sven; Omstead, Ashten N.; Jobe, Blair A.; Ayazi, Shahin

doi:10.1016/s0016-5085(22)63854-x

Cited by 3 publications

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“…Bolus clearance issues often accompany abnormal esophageal motility but are not fully integrated into the classification. Addition of bolus clearance to CC v4.0 criteria for IEM improved its prediction of outcome following magnetic sphincter augmentation [17].…”

Section: Impedance Monitoringmentioning

confidence: 99%

Esophageal motility disorder – has Chicago classification v4.0 simplified our management?

Edeani,

Massey

2023

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Review purpose Addressing dysphagia is vital due to its prevalence and impact on healthcare expenditure. While high resolution manometry (HRM) effectively evaluates esophageal dysphagia, its role in oropharyngeal dysphagia and upper esophageal sphincter (UES) dysfunction remains debated. The fourth iteration of the Chicago classification (CC) offers an algorithmic approach for diagnosing abnormal motor patterns via HRM. This review assesses the CC's impact on dysphagia management. Recent insights The Chicago classification version 4.0 emphasizes auxiliary and provocative techniques when the algorithm falls short of a conclusive diagnosis. It introduces stricter criteria for previously ambiguous conditions like ineffective motility and esophagogastric junction outflow obstruction. This version also introduces the concept of conclusive and inconclusive classifications based on symptoms, provocation maneuvers, and supportive testing minimizing ambiguity. Summary The Chicago classification v4.0 remains a useful tool for the diagnosis of well characterized esophageal motility disorders. However, major limitations include reliance on HRM and a focus on distal esophagus contractile characteristics without considering proximal esophagus or upper esophageal sphincter, both of which can sometimes be the only evident abnormality in patients with dysphagia. Despite efforts to reduce ambiguity, diagnostic challenges persist. These limitations can be addressed in future updates

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Section: Impedance Monitoringmentioning

confidence: 99%

Esophageal motility disorder – has Chicago classification v4.0 simplified our management?

Edeani,

Massey

2023

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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“…12 Another group found that IEM is poorly predictive of dysphagia after placement of a magnetic sphincter augmentation device, even when applying the more stringent criteria of Chicago Classification v4.0. 13 In keeping with the question of therapy for IEM posed by Reddy et al, many authors have observed statistically significant improvements in the percentage of intact peristaltic sequences and in distal esophageal amplitudes in IEM patients after fundoplication, [14][15][16] likely the result of definitive control of abnormal distal esophageal acid exposure and its effects on esophageal physiology. Each of these studies has demonstrated normalization of peristalsis in a percentage of IEM patients following antireflux surgery.…”

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confidence: 91%

Commentary on Medical Therapy for Ineffective Esophageal Motility: A Systematic Review—Surgical Considerations

Tatum

2023

Foregut: The Journal of the American Foregut Society

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Magnetic sphincter augmentation and high-resolution manometry: impact of biomechanical properties on esophageal motility and clinical significance for selection and outcomes

Eriksson

Jobe

Ayazi

2022

Diseases of the Esophagus

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Summary Magnetic sphincter augmentation (MSA)was introduced as an alternative to laparoscopic Nissen fundoplication (LNF). This reproducible, outpatient procedure addresses the etiology of gastroesophageal reflux disease by implanting a ring of magnetic beads across the esophagogastric junction (EGJ). MSA is designed to resist effacement of the lower esophageal sphincter (LES) and, similar to LNF, results in restoration of anti-reflux barrier competency by increasing overall length, intraabdominal length and resting pressure of the sphincter. However, the novel use of magnets to augment the physiology of the LES poses unique challenges to the physiology of the EGJ and esophagus. These impacts are best revealed through manometry. The degree of restrictive forces at the EGJ, as measured by intrabolus pressure and integrated relaxation pressure, is higher after MSA compared with LNF. In addition, contrary to the LNF, which retains neurohormonal relaxation capability during deglutition, the magnetic forces remain constant until forcibly opened. Therefore, the burden of overcoming EJG resistance is placed solely on the esophageal body contractile force, as measured by distal contractile integral and distal esophageal amplitude. The main utility of preoperative manometry is in determining whether a patient’s esophagus has sufficient contractility or peristaltic reserve to adapt to the challenge of an MSA. Manometric thresholds predictive of MSA outcomes deviate from those used to define named Chicago Classification motility disorders. Therefore, individual preoperative manometric characteristics should be analyzed to aid in risk stratification and patient selection prior to MSA.

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301: Ineffective Esophageal Motility: The Impact of Change of Criteria in Chicago Classification Version 4.0 (CCV4.0) on Predicting Surgical Outcome

Cited by 3 publications

References 0 publications

Esophageal motility disorder – has Chicago classification v4.0 simplified our management?

Esophageal motility disorder – has Chicago classification v4.0 simplified our management?

Commentary on Medical Therapy for Ineffective Esophageal Motility: A Systematic Review—Surgical Considerations

Magnetic sphincter augmentation and high-resolution manometry: impact of biomechanical properties on esophageal motility and clinical significance for selection and outcomes

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