Endoscopic pressure study integrated system for the diagnosis of achalasia

Abstract

ObjectivesThe endoscopic pressure study integrated system (EPSIS) is a novel diagnostic tool used to evaluate lower esophageal sphincter (LES) function. EPSIS allows the measurement of intragastric pressure (IGP) during gastric insufflation through esophagogastroduodenoscopy (EGD) and records its pressure waveform. This study aimed to assess the usefulness and applicability of EPSIS as an adjunct diagnostic modality for achalasia.MethodsThis case‐control study was conducted using a database of patients who underwent EGD, barium swallow (BS), high‐resolution manometry (HRM), and EPSIS between January 2022 and December 2022. The achalasia (experimental) group (n = 35) consisted of patients with a definitive diagnosis of achalasia. The control group (n = 34) consisted of patients with no abnormalities in EGD, BS, or HRM and no abnormal acid reflux confirmed with 24‐hour pH‐impedance monitoring. EPSIS findings were compared between the two groups and characterized by waveform pattern (uphill or flat), maximum IGP (IGP‐Max), pressure difference, and the gradient of the waveform.ResultsAll patients in the achalasia group showed an uphill pattern, in contrast to 21 patients (61.8%) in the control group. IGP‐Max demonstrated the best diagnostic accuracy for achalasia, with a cutoff value of 15.8 mmHg (100% sensitivity, 58.8% specificity, and AUC: 0.78). The pressure gradient also demonstrated good diagnostic accuracy, with a cutoff value of 0.40 mmHg/sec (80% sensitivity, 61.8% specificity, and AUC: 0.76).ConclusionThis study demonstrated that EPSIS can be applied as a diagnostic modality in patients with achalasia.