Association between endoscopic pressure study integrated system (EPSIS) and high-resolution manometry

Abstract

Background and study aims The endoscopic pressure study integrated system (EPSIS), a novel diagnostic tool for gastroesophageal reflux disease (GERD), allows evaluation of the anti-reflux barrier using endoscopy by monitoring the intragastric pressure (IGP) during insufflation. In this study, we evaluated the association between EPSIS results and lower esophageal sphincter (LES) function measured by high-resolution manometry (HRM) to elucidate whether EPSIS can evaluate the LES function. Patients and methods A retrospective, single-center study of patients with GERD symptoms who underwent endoscopy, pH-impedance monitoring, EPSIS, and HRM was conducted. The primary outcome was basal LES pressure and the secondary outcomes were end-respiratory LES pressure and integrated relaxation pressure (IRP). As EPSIS parameters, the following were measured: 1) pressure difference (mmHg), the difference between maximum and basal IGP; and 2) pressure gradient (mmHg/s), calculated by dividing pressure difference by the insufflating time. Pressure difference < 4.7 mmHg or pressure gradient < 0.07 mmHg/s was defined as an EPSIS GERD pattern. Results Forty-seven patients (median age: 53 years, 37 female) were analyzed. Pressure difference and pressure gradient significantly correlated with basal LES pressure (ρ = 0.29; P = 0.04 and ρ = 0.29; P = 0.04). Patients with EPSIS GERD pattern showed significantly lower basal LES pressure [13.2 (4.8–26.6) vs 25.3 (10.4–66.7) mmHg, P = 0.002], lower end-respiratory LES pressure [8.5 (1.1–15.9) vs 15.5 (1.9–43.9) mmHg, P = 0.019] and lower IRP [5.9 (1.0–12.0) vs 9.8 (1.3–17.8) mmHg, P = 0.020]. Conclusions This study showed a close association between EPSIS results and LES pressures measured by HRM. This indicates that EPSIS can evaluate the LES function during endoscopy and endorse the role of EPSIS as a diagnostic tool for GERD.

Endoscopic pressure study integrated system for the diagnosis of achalasia

“…The flat pattern and the lower value of IGP‐Max were associated with acid reflux, 1 and the pressure difference and pressure gradient were also significantly associated with acid reflux 2 . In addition, a significant association between EPSIS parameters and LES pressures measured by HRM was confirmed 8 . Patients with GERD patterns (the low values of the pressure difference and gradient) on EPSIS showed significantly lower basal LES pressure.…”

“…2 In addition, a significant association between EPSIS parameters and LES pressures measured by HRM was confirmed. 8 Patients with GERD patterns (the low values of the pressure difference and gradient) on EPSIS showed significantly lower basal LES pressure.…”

The utility of endoscopic pressure study integrated system (EPSIS) as an adjunctive metric for GERD Diagnosis: A Japanese multicenter prospective study

“…Conclusions This study highlights the potential of the pressure gradient measured by EPSIS during endoscopic assessment as an adjunctive metric for consolidating GERD diagnosis 1 2 3 .…”

Functional Endoscopy

“…HRM measurements were conducted concurrently with the EPSIS study. This integration allowed the confirmation that the burp observed during the procedure coincides with the release of scope holding, which is accompanied by LES contraction [ 13 ]. In the group classified as having a “suspected GERD pattern” according to EPSIS, the LES resting pressure, as assessed by esophageal manometry, was significantly lower compared to the “normal pattern” group (13.2 vs. 25.3 mm Hg, p = 0.002).…”