Assessing bolus retention in achalasia using high-resolution manometry with impedance: a comparator study with timed barium esophagram.
OBJECTIVE
The aim of this study was to assess whether high-resolution impedance manometry (HRIM) could be used to assess bolus retention similar to the timed barium esophagram (TBE).


METHODS
Twenty achalasia patients (10 males, aged 21-79 years) were prospectively evaluated with HRIM and TBE to determine the correlation between barium column height and the impedance bolus height (IBH). The TBE protocol used a 200-ml barium challenge and the HRIM protocol used a 200-ml saline challenge protocol. Both protocols were performed in an upright position and the heights of the barium and impedance columns were measured at 1 and 5 min. Analysis of IBH was performed with a topographic technique and a spatial impedance variation plot.


RESULTS
There was no significant difference between the median IBH and barium column at 1 min (IBH: 12.0 cm (interquartile range (IQR), 8.0-18.0); TBE: 12.0 cm (IQR, 7.0-19.0); P=0.90) or at 5 min (IBH: 11.0 cm (IQR, 1.0-17.0); TBE: 9.0 cm (IQR, 4.0-12.0); P=0.47). In addition, the correlation between the two measurements at 1 and 5 min was 0.60 and 0.86, respectively. Using a barium column or impedance height of >5.0 as a definition of bolus retention was associated with 75% concordance at 1 min and 95% concordance at 5 min.


CONCLUSIONS
There was excellent agreement between TBE and high-resolution impedance manometry (HRIM) for assessing bolus retention at 5 min. Thus, HRM with impedance may be used as a single test to assess bolus retention and motor function in the management of achalasia.
Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
Yu K
YK
Cho
Division of Gastroenterology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Anna M
AM
Lipowska
1] Division of Gastroenterology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA [2] Department of Thoracic Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, Qubec, Canada.
Frédéric
F
Nicodème
Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Ezra N
EN
Teitelbaum
Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Eric S
ES
Hungness
Division of Gastroenterology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Elyse R
ER
Johnston
Division of Gastroenterology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Andrew
A
Gawron
Division of Gastroenterology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Peter J
PJ
Kahrilas
Division of Gastroenterology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
John E
JE
Pandolfino
D000328:Adult; D000368:Aged; D001466:Barium Sulfate; D003938:Diagnostic Techniques, Digestive System; D017097:Electric Impedance; D004931:Esophageal Achalasia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004947:Esophagus / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D005772:Gastrointestinal Transit; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D055815:Young Adult
D001466:Barium Sulfate