title: Impedance Analysis Using High-resolution Impedance Manometry Facilitates Assessment of Pharyngeal Residue in Patients With Oropharyngeal Dysphagia.
abstract: OBJECTIVE
  Impedance analysis using high-resolution impedance manometry (HRIM) enables the recognition of pharyngeal residue in patients with oropharyngeal dysphagia. The aims of this study were to evaluate appropriate criteria for impedance analysis in a large patient cohort, as well as the diagnostic accuracy and agreement of analysis performed by HRIM trainees.
  
  
  METHODS
  We reviewed 33 controls (13 males; median age, 61.2 years) and 104 oropharyngeal dysphagia patients (61 males; median age, 70.4 years) who underwent a flexible endoscopic evaluation of swallowing study (FEES) and HRIM. Two experts compared the pharyngeal residue on FEES and impedance color pattern at 1,000, 1,500 and 2,000 Ω of the impedance bar. Three trainees were given a 60 minutes tutorial to determine the diagnostic accuracy and agreement of this analysis.
  
  
  RESULTS
  The diagnostic sensitivity of experts for predicting liquid residue was 73.1% for 1,000 Ω, 96.2% for 1,500 Ω and 100% for 2,000 Ω. Significantly higher sensitivity was observed at 1,500 Ω compared to 1,000 Ω (P < 0.001). The diagnostic specificity of experts for liquid residue was 98.3% for 1,000 Ω, 96.6% for 1,500 Ω and 83.1% for 2,000 Ω. There was a higher specificity at 1,500 Ω compared to 2,000 Ω (P = 0.008). The κ value among the 3 trainees was 0.89 and the diagnostic accuracy of the trainees for liquid residue was comparable to that of the experts.
  
  
  CONCLUSIONS
  The impedance analysis at 1,500 Ω provides more accurate information for the detection of liquid residue, irrespective of the level of expertise.
authors.affiliation: Institute for Digestive Research, Digestive Disease Center Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Tae Hee
authors.initials: TH
authors.lastname: Lee
authors.affiliation: Institute for Digestive Research, Digestive Disease Center Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Joon Seong
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Gyeonggi-do, Korea.
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Hong
authors.affiliation: Biostatistical Consulting Unit, Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Ji Sung
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Institute for Digestive Research, Digestive Disease Center Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Seong Ran
authors.initials: SR
authors.lastname: Jeon
authors.affiliation: Department of Internal Medicine, Soonchunhyang University Hospital, Gumi, Gyeongsangbuk-do, Korea.
authors.forename: Wan Jung
authors.initials: WJ
authors.lastname: Kim
authors.affiliation: Institute for Digestive Research, Digestive Disease Center Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Hyun Gun
authors.initials: HG
authors.lastname: Kim
authors.affiliation: Institute for Digestive Research, Digestive Disease Center Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Joo Young
authors.initials: JY
authors.lastname: Cho
authors.affiliation: Institute for Digestive Research, Digestive Disease Center Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Jin-Oh
authors.initials: JO
authors.lastname: Kim
authors.affiliation: Institute for Digestive Research, Digestive Disease Center Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Jun-Hyung
authors.initials: JH
authors.lastname: Cho
authors.affiliation: Institute for Digestive Research, Digestive Disease Center Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Mi-Young
authors.initials: MY
authors.lastname: Kim
authors.affiliation: Institute for Digestive Research, Digestive Disease Center Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Soon Ha
authors.initials: SH
authors.lastname: Kwon
keywords: Deglutition disorders, Diagnosis, Pharynx