Inter‐ and intrarater reliability of the Chicago Classification in pediatric high‐resolution esophageal manometry recordings

Abstract

Background The Chicago Classification (CC) facilitates interpretation of high‐resolution manometry (HRM) recordings. Application of this adult based algorithm to the pediatric population is unknown. We therefore assessed intra and interrater reliability of software‐based CC diagnosis in a pediatric cohort. Methods Thirty pediatric solid state HRM recordings (13M; mean age 12.1 ± 5.1 years) assessing 10 liquid swallows per patient were analyzed twice by 11 raters (six experts, five non‐experts). Software‐placed anatomical landmarks required manual adjustment or removal. Integrated relaxation pressure (IRP4s), distal contractile integral (DCI), contractile front velocity (CFV), distal latency (DL) and break size (BS), and an overall CC diagnosis were software‐generated. In addition, raters provided their subjective CC diagnosis. Reliability was calculated with Cohen's and Fleiss’ kappa (κ) and intraclass correlation coefficient (ICC). Key Results Intra‐ and interrater reliability of software‐generated CC diagnosis after manual adjustment of landmarks was substantial (mean κ = 0.69 and 0.77 respectively) and moderate‐substantial for subjective CC diagnosis (mean κ = 0.70 and 0.58 respectively). Reliability of both software‐generated and subjective diagnosis of normal motility was high (κ = 0.81 and κ = 0.79). Intra‐ and interrater reliability were excellent for IRP4s, DCI, and BS. Experts had higher interrater reliability than non‐experts for DL (ICC = 0.65 vs ICC = 0.36 respectively) and the software‐generated diagnosis diffuse esophageal spasm (DES, κ = 0.64 vs κ = 0.30). Among experts, the reliability for the subjective diagnosis of achalasia and esophageal gastric junction outflow obstruction was moderate‐substantial (κ = 0.45–0.82). Conclusions & Inferences Inter‐ and intrarater reliability of software‐based CC diagnosis of pediatric HRM recordings was high overall. However, experience was a factor influencing the diagnosis of some motility disorders, particularly DES and achalasia.

An ANMS‐NASPGHAN consensus document on esophageal and antroduodenal manometry in children

“…This potential for incorrect diagnosis when applying the adult CC criteria to pediatric patients might strongly influence treatment choice. Studies have also shown that the interpretation of HRM is reproducible, but there are still some specific areas that may need more validation.…”

Impaired bolus clearance in asymptomatic older adults during high‐resolution impedance manometry

“…The DL (s) was determined as the time from swallow onset (either through upper esophageal sphincter [UES] relaxation or the onset of impedance drop at the most proximal channel) to the CDP. 27 Pressure-flow analysis Data were exported as comma separated values and esophageal PFA was performed using MATLAB based automated software (Esophageal AIMplot software; T Omari © ; The MathWorks Inc, Natick, MA, USA). Five observer-determined regions of interest were used to guide analyses.…”

“…The CFV (cm/s) was determined as the slope of the tangent approximating the 30 mmHg isocontour between the proximal transition zone and contractile deceleration point (CDP). The DL (s) was determined as the time from swallow onset (either through upper esophageal sphincter [UES] relaxation or the onset of impedance drop at the most proximal channel) to the CDP …”

The Potential Benefits of Applying Recent Advances in Esophageal Motility Testing in Patients with Esophageal Atresia

“…Therefore, the available diagnostic criteria need to be adjusted for age and size, specifically the integrated relaxation pressure (IRP4) reflecting deglutitive EGJ relaxation and distal latency (3). Although the CC appears to be applicable for use in the general pediatric population (4, 5), its use in EA as a specific patient subgroup requires further consideration. EA patients often show no motor patterns, and therefore bolus transport to, and through, the EGJ needs to be considered.…”