The utility of endoscopic pressure study integrated system (EPSIS) as an adjunctive metric for GERD Diagnosis: A Japanese multicenter prospective study

Aims Functional endoscopy, integrating motor function assessments into routine endoscopic examinations, significantly advances gastrointestinal diagnostics. The novel functional testing tool, the Endoscopic Pressure Study Integrated System (EPSIS), offers a unique approach to evaluating the anti-reflux barrier. It achieves this by monitoring and recording intragastric pressure (IGP) during gastric insufflation in upper endoscopy, functioning as a stress test to assess the lower esophageal sphincter's (LES) functionality. This study explored the association between IGP and pH-impedance monitoring, specifically focusing on characterizing the IGP waveform.

Methods This multicenter prospective cohort study was conducted at Japanese academic hospitals between June 2020 and October 2023 that enrolled patients undergoing upper endoscopy, pH-impedance monitoring, and EPSIS. The primary objective was to evaluate the association between EPSIS and acid reflux parameters. The intragastric pressure waveform was characterized by assessing the gradient (mmHg/s), calculated as the pressure difference divided by the insufflation time. Abnormal acid reflux was defined as acid exposure time (AET)>6%, and pathological reflux was defined as total reflux episodes>80/day based on the Lyon Consensus.

Results Analysis of 174 subjects from six centers revealed that 48 patients (25.8%) tested positive for abnormal acid reflux, while 28 patients (17.0%) exhibited pathological reflux. Patients with abnormal AET and pathological reflux demonstrated lower pressure gradients (0.18 mmHg/s vs. 0.23 mmHg/s, P=0.015, and 0.17 mmHg/s vs. 0.24 mmHg/s, P=0.0097, respectively). In multivariate analysis, the pressure gradient of the IGP waveform and the presence of erosive esophagitis remained significant predictors of abnormal acid reflux (adjusted odds ratio [aOR] per 0.01 unit=0.97, 95% CI 0.93-0.99, and aOR=2.33, 95% CI 1.05-5.20, respectively). In addition, the pressure gradient of the IGP waveform was the strongest predictors of pathological reflux (aOR per 0.01 unit=0.95, 95% CI 0.90-0.99).

Conclusions This study highlights the potential of the pressure gradient measured by EPSIS during endoscopic assessment as an adjunctive metric for consolidating GERD diagnosis [1] [2] [3].

Publikationsverlauf

Artikel online veröffentlicht:
15. April 2024

• References

• 1 Fujiyoshi Y, Inoue H, Shimamura Y. et al. Association between endoscopic pressure study integrated system (EPSIS) and high-resolution manometry. Endosc Int Open 2022; 10: E762-E768
• 2 Shimamura Y, Inoue H, Rodriguez de Santiago E. et al. Characterization of intragastric pressure waveform in endoscopic pressure study integrated system: Novel diagnostic device for gastroesophageal reflux disease. Dig Endosc 2021; 33: 780-787
• 3 Inoue H, Shimamura Y, Rodriguez de Santiago E. et al. Diagnostic performance of the endoscopic pressure study integrated system (EPSIS): a novel diagnostic tool for gastroesophageal reflux disease. Endoscopy 2019; 51: 759-762