Measurement of peak esophageal luminal cross‐sectional area utilizing nadir intraluminal impedance

Zifan, Ali; Ledgerwood-Lee, Melissa M.; Mittal, Ravinder K.

doi:10.1111/nmo.12571

Cited by 21 publications

(29 citation statements)

References 21 publications

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“…Intraluminal esophageal impedance has been in use to record gastroesophageal reflux and bolus movements in the esophagus for more than 20 years (12,16). Studies show that one may also record luminal distension using intraluminal impedance measurements (8,20). HRM impedance (HRMZ) catheters allow impedance measurements at every 2 cm along the entire length of the esophagus.…”

Section: Introductionmentioning

confidence: 99%

Topographical plots of esophageal distension and contraction: effects of posture on esophageal peristalsis and bolus transport

Zifan

Song

Youn

et al. 2019

American Journal of Physiology-Gastrointestinal and Liver Physi

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Each swallow induces a wave of inhibition followed by contraction in the esophagus. Unlike contraction, which can easily be measured in humans using high-resolution manometry (HRM), inhibition is difficult to measure. Luminal distension is a surrogate of the esophageal inhibition. The aim of this study was to determine the effect of posture on the temporal and quantitative relationship between distension and contraction along the entire length of the esophagus in normal healthy subjects by using concurrent HRM, HRM impedance (HRMZ), and intraluminal ultrasound (US). Studies were conducted in 15 normal healthy subjects in the supine and Trendelenburg positions. Both manual and automated methods were used to extract quantitative pressure and impedance-derived features from the HRMZ recordings. Topographical plots of distension and contraction were visualized along the entire length of the esophagus. Distension was also measured from the US images during 10-ml swallows at 5 cm above the lower esophageal sphincter. Each swallow was associated with luminal distension followed by contraction, both of which traversed the esophagus in a sequential/peristaltic fashion. Luminal distension (US) and esophageal contraction amplitude were greater in the Trendelenburg compared with the supine position. Length of esophageal breaks (in the transition zone) were reduced in the Trendelenburg position. Change in posture altered the temporal relationship between distension and contraction, and bolus traveled closer to the esophageal contraction in the Trendelenburg position. Topographical contraction-distension plots derived from HRMZ recordings is a novel way to visualize esophageal peristalsis. Future studies should investigate if abnormalities of esophageal distension are the cause of functional dysphagia. NEW & NOTEWORTHY Ascending contraction and descending inhibition are two important components of peristalsis. High-resolution manometry only measures the contraction phase of peristalsis. We measured esophageal distension from intraluminal impedance recordings and developed novel contraction-distension topographical plots to prove that similar to contraction, distension also travels in a peristaltic fashion. Change in posture from the supine to the Trendelenburg position also increased the amplitude of esophageal distension and contraction and altered the temporal relationship between distension and contraction.

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Section: Introductionmentioning

confidence: 99%

Topographical plots of esophageal distension and contraction: effects of posture on esophageal peristalsis and bolus transport

Zifan

Song

Youn

et al. 2019

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…Despite the obvious potential in the esophagus, this approach appears to have been successful only for a few groups. 15,16 Indications for mucosal impedance, intraluminal impedance, and FLIP Combined impedance-pH for reflux monitoring MII-pH is considered by some as the gold-standard test for GERD. 50 However, it may not be necessary for every case undergoing GERD evaluation.…”

Section: Other Impedance Technologies and New Developmentsmentioning

confidence: 99%

“…Recently, efforts have been made to combine the two approaches, that is, to derive luminal area and distensibility from intraluminal impedance measurements. 15,16 The various impedance technologies, including their historical aspects, limitations, and applications, are described below.…”

Section: Introductionmentioning

confidence: 99%

Impedance in the evaluation of the esophagus

Sloan

Kuribayashi

et al. 2020

Annals of the New York Academy of Sciences

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The aim of this paper is to review esophageal electrical impedance technologies and to discuss the use of these technologies for physiological measurements, diagnostics, and therapy of esophageal disease. In order to develop a better understanding of the pathophysiology of and improve the diagnosis of esophageal disorders, such as gastroesophageal reflux disease (GERD) and achalasia, several new diagnostic tests, including intraluminal impedance, esophageal mucosal impedance, and the functional luminal imaging probe, have been developed. These technologies have proven valuable for assessment of the esophagus in recent years. They provide information on esophageal flow properties, mucosal integrity, lumen shape, and distensibility in esophageal disorders, in particular for GERD and achalasia. Despite their promise and novel clinical studies, the potential of these technologies has been far from realized. New multidisciplinary approaches will contribute to our understanding and interpretation of esophageal impedance data and disease mechanisms.

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“…The other issue is leakage of current through the esophagus wall (parallel conductance), which was addressed by Zifan et al by double saline methodology. 3 However, for practical reasons, the use of Trendelenburg position during manometry may not be acceptable to all patients and possibly pose aspiration risk.…”

Section: Introductionmentioning

confidence: 99%

Novel gel bolus to improve impedance‐based measurements of esophageal cross‐sectional area during primary peristalsis

Ledgerwood

Zifan

Lin

et al. 2020

Neurogastroenterology Motil

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Introduction: Intraluminal esophageal impedance (ILEE) has the potential to measure esophageal luminal distension during swallow-induced peristalsis in the esophagus. A potential cause of inaccuracy in the ILEE measurement is the swallow-induced air in the bolus. Aim: Compare a novel gel bolus to the current alternatives for the measurement of impedance-based luminal distension (cross-sectional area, CSA) during primary peristalsis. Methods: 12 healthy subjects were studied using high-resolution impedance manometry (HRMZ) and concurrently performed intraluminal ultrasound (US) imaging of the esophagus. Three test bolus materials were used: 1) novel gel, 2) 0.5 N saline, and 3) commercially available Diversatek EFTV viscous. Testing was performed in the supine and Trendelenburg (−15°) positions. US imaging assessed air in the bolus and luminal CSA. The Nadir impedance values were correlated to the US measured CSA. A custom Matlab software was used to assess the bolus travel times and impedance-based luminal CSA. Results:The novel gel bolus had the least amount of air in the bolus during its passage through the esophagus, as assessed by US image analysis. The novel gel bolus in the supine and Trendelenburg positions had the best linear fit between the US measured CSA and nadir impedance value (R 2 = 0.88 & R 2 = 0.90). The impedance-based calculation of the CSA correlated best with the US measured CSA with the use of the novel gel bolus. Conclusion:We suggest the use of novel gel to assess distension along with contraction during routine clinical HRM testing.

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Measurement of peak esophageal luminal cross‐sectional area utilizing nadir intraluminal impedance

Cited by 21 publications

References 21 publications

Topographical plots of esophageal distension and contraction: effects of posture on esophageal peristalsis and bolus transport

Topographical plots of esophageal distension and contraction: effects of posture on esophageal peristalsis and bolus transport

Impedance in the evaluation of the esophagus

Novel gel bolus to improve impedance‐based measurements of esophageal cross‐sectional area during primary peristalsis

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