Is barium esophagram enough? Comparison of esophageal motility found on barium esophagram to high resolution manometry

Zambito, Giuseppe; Roether, Robert; Kern, Brittany S.; Conway, Ryan; Scheeres, David E.; Banks-Venegoni, Amy

doi:10.1016/j.amjsurg.2020.11.028

Cited by 6 publications

(6 citation statements)

References 9 publications

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“…Studies on the diagnostic accuracy of esophagram and FLIP for identifying esophageal motility abnormalities generally have used HRM as the gold standard for comparison. 2,11,12,18 However, the most recent version of the CCv4.0 acknowledges that HRM alone is not sufficient for the clinically relevant diagnoses of EGJOO, distal esophageal spasm, and hypercontractile esophagus. Given the high frequency of discrepancies we found among HRM, FLIP, and esophagram for identifying LES obstruction, we explored the utility of these tests, individually and in combination, for agreement with a consensus clinical diagnosis rendered by a panel of esophagologists (who had access to all diagnostic test results and clinical presentation).…”

Section: Discussionmentioning

confidence: 99%

“…At our Center for Esophageal Diseases, a tertiary referral center, we have observed that disagreement among HRM, FLIP, and esophagram in the evaluation of LES function is quite common and often results in considerable diagnostic confusion 10 . Given the individual strengths and weaknesses of HRM, FLIP, and esophagram to evaluate esophageal function, prior studies have attempted to assess agreement between testing modalities 11–13 . However, most of these studies have been limited to comparisons between two tests only.…”

Section: Introductionmentioning

confidence: 99%

“…10 Given the individual strengths and weaknesses of HRM, FLIP, and esophagram to evaluate esophageal function, prior studies have attempted to assess agreement between testing modalities. [11][12][13] However, most of these studies have been limited to comparisons between two tests only. The aim of our study was to evaluate the frequency of discrepancy among all three tests (HRM, FLIP, and esophagram with BaTab) in identifying LES obstruction.…”

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confidence: 99%

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Frequent discrepancies among diagnostic tests for detecting lower esophageal sphincter‐related obstruction

Reddy,

Ellison,

Cipher

et al. 2023

Neurogastroenterology Motil

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BackgroundThere are frequent discrepancies among high‐resolution manometry (HRM), functional lumen imaging probe (FLIP), and esophagram in identifying lower esophageal sphincter (LES)‐related obstruction. We aimed to determine the frequency of those discrepancies and how they influenced clinical treatment/outcomes.MethodsWe identified patients who had all three tests (HRM, FLIP, and esophagram) and endoscopy performed for evaluation of esophageal symptoms in our Center for Esophageal Diseases. Discrepancies among the tests for the presence of LES obstruction were noted, and the performance of individual tests was compared against a consensus opinion rendered by a panel of esophagologists. Binary logistical regression was performed, and ROC curves were generated for prediction of the consensus clinical diagnosis of LES obstruction.Key ResultsA total of 126 patients (mean age 57.9 ± 17.0 years; 67% female) met inclusion criteria. All three tests agreed on the presence or absence of LES obstruction in only 72 (57%) patients [no LES obstruction in 57 (45%), LES obstruction in 15 (12%)]. Thirteen patients (10%) had a change in management based on additional findings on FLIP +/− esophagram not seen on HRM with 69% having symptomatic improvement after LES‐directed intervention. FLIP was the strongest predictor of a consensus diagnosis of LES obstruction by logistic regression and ROC (OR 23.36, AUC 0.796), followed by HRM (OR 15.41, AUC 0.764).Conclusions & InferenceHigh‐resolution manometry, functional lumen imaging probe, and esophagram each have considerable limitations for identifying LES obstruction, and discrepancies among these tests occur frequently. Multimodal testing is often required for adequate evaluation of LES‐related obstruction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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Frequent discrepancies among diagnostic tests for detecting lower esophageal sphincter‐related obstruction

Reddy,

Ellison,

Cipher

et al. 2023

Neurogastroenterology Motil

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“…23 Concordance between esophagram and HRM for detecting esophageal dysmotility is only 46%. 24 The primary value of esophagram in ARS workup lies in evaluating for short esophagus and hiatal hernia anatomy. 25 EndoFLIP™ catheters range from 6.4 to 16 cm, accommodating different numbers of impedance sensors within the balloon.…”

Section: Esophageal Function Testingmentioning

confidence: 99%

The Value of Esophageal Function Testing in Antireflux Surgery

Hedberg

Ujiki

2021

Foregut: The Journal of the American Foregut Society

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“…Esophagoscopy is the gold standard for esophageal cancer diagnosis, but it is both invasive and expensive (3). Barium esophagram can simultaneously detect morphologic and functional abnormalities in the esophagus and is thus a valuable technique for the assessment of esophageal cancer (4)(5)(6)(7). In addition, due to its inexpensive and noninvasive features, as well as its widespread availability, the barium esophagram is usually prioritized over other techniques, such as endoscopy, for clinical diagnostic selection (4).…”

Section: Introductionmentioning

confidence: 99%

Development of a Deep Learning System to Detect Esophageal Cancer by Barium Esophagram

et al. 2022

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BackgroundImplementation of deep learning systems (DLSs) for analysis of barium esophagram, a cost-effective diagnostic test for esophageal cancer detection, is expected to reduce the burden to radiologists while ensuring the accuracy of diagnosis.ObjectiveTo develop an automated DLS to detect esophageal cancer on barium esophagram.MethodsThis was a retrospective study using deep learning for esophageal cancer detection. A two-stage DLS (including a Selection network and a Classification network) was developed. Five datasets based on barium esophagram were used for stepwise training, validation, and testing of the DLS. Datasets 1 and 2 were used to respectively train and test the Selection network, while Datasets 3, 4, and 5 were respectively used to train, validate, and test the Classification network. Finally, a positioning box with a probability value was outputted by the DLS. A region of interest delineated by experienced radiologists was selected as the ground truth to evaluate the detection and classification efficiency of the DLS. Standard machine learning metrics (accuracy, recall, precision, sensitivity, and specificity) were calculated. A comparison with the conventional visual inspection approach was also conducted.ResultsThe accuracy, sensitivity, and specificity of our DLS in detecting esophageal cancer were 90.3%, 92.5%, and 88.7%, respectively. With the aid of DLS, the radiologists’ interpretation time was significantly shortened (Reader1, 45.7 s vs. 72.2 s without DLS aid; Reader2, 54.1 s vs. 108.7 s without DLS aid). Respective diagnostic efficiencies for Reader1 with and without DLS aid were 96.8% vs. 89.3% for accuracy, 97.5% vs. 87.5% for sensitivity, 96.2% vs. 90.6% for specificity, and 0.969 vs. 0.890 for AUC. Respective diagnostic efficiencies for Reader2 with and without DLS aid were 95.7% vs. 88.2% for accuracy, 92.5% vs. 77.5% for sensitivity, 98.1% vs. 96.2% for specificity, and 0.953 vs. 0.869 for AUC. Of note, the positioning boxes outputted by the DLS almost overlapped with those manually labeled by the radiologists on Dataset 5.ConclusionsThe proposed two-stage DLS for detecting esophageal cancer on barium esophagram could effectively shorten the interpretation time with an excellent diagnostic performance. It may well assist radiologists in clinical practice to reduce their burden.

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Is barium esophagram enough? Comparison of esophageal motility found on barium esophagram to high resolution manometry

Cited by 6 publications

References 9 publications

Frequent discrepancies among diagnostic tests for detecting lower esophageal sphincter‐related obstruction

Frequent discrepancies among diagnostic tests for detecting lower esophageal sphincter‐related obstruction

The Value of Esophageal Function Testing in Antireflux Surgery

Development of a Deep Learning System to Detect Esophageal Cancer by Barium Esophagram

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