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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(06): E762-E768
DOI: 10.1055/a-1790-6141
Original article

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

Yusuke Fujiyoshi
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
,
Haruhiro Inoue
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
,
Yuto Shimamura
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
,
Mary Raina Angeli Fujiyoshi
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
,
Enrique Rodriguez de Santiago
2   Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
,
Yohei Nishikawa
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
,
Akiko Toshimori
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
,
Mayo Tanabe
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
,
Kazuya Sumi
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
,
Masashi Ono
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
,
Yugo Iwaya
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
,
Haruo Ikeda
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
,
Manabu Onimaru
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
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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.



Publication History

Received: 17 July 2021

Accepted after revision: 21 December 2021

Article published online:
10 June 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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