Sa1191 High-Resolution Esophageal Pressure Topography (HREPT) in Asymptomatic Volunteers. a Comparative Study Between Solid-State and Water-Perfused Systems

AGA Abstracts

with a negative response (p < 0.001). There was no significant difference in the proportion of the segmental length among the striated muscle segment, proximal smooth muscle segment, and distal smooth muscle segment. While the pressure volume of the proximal segment was significantly higher in the positive responders than the negative responders (900.4 ± 91.5 mmHg cm(-1) s(-1) vs. 780.5 ± 133.3 mmHg cm(-1) s(-1), p = 0.017), the pressure volume of the distal segment was significantly lower in the positive responders (1914.0 ± 159.8 mmHg cm(-1) s(-1)vs. 2140.5 ± 276.2 mmHg cm(-1) s(-1), p = 0.014). A prominent shifting in pressure volume to the distal segment was observed in the negative responders compared to the positive responders (segmental ratio of pressure volume (SRPV): 2.9 ± 0.5 vs. 2.1 ± 0.1, p < 0.001), and 2.39 was found to be the SRPV that best differentiated positive and negative responders (area under curve, 0.88; 95% confidence intervals, 0.71-0.97; p < 0.001). On the other hand, there was no significant difference between the groups in the segmental ratios regarding segmental length and maximal wave amplitude. CONCLUSIONS: A low SRPV was associated with a positive response to high-dose PPI treatment in patients with FCP. Sa1189

Sa1191

Utilizing Intrabolus Pressure and EGJ Relaxation Pressure to Predict Esophageal Bolus Transit in Dysphagia Patients Moo-In Park, Su Hyeon Jeong, Hyung Hun Kim, Seun-Ja Park, Won Moon, Eun Taek Park, Sung Eun Kim

High-Resolution Esophageal Pressure Topography (HREPT) in Asymptomatic Volunteers. a Comparative Study Between Solid-State and Water-Perfused Systems Monica R. Zavala-Solares, Elisa Saleme, Florencia Vargas-Vorackova, Miguel A. Valdovinos

Background/Aims: High-resolution manometry (HRM), with a greatly increased number of recording sites and decreased spacing between them, is sufficient to resolve the dynamic simultaneous relationship between intrabolus pressure (IBP) and EGJ relaxation pressure. We aimed to determine whether IBP overcoming integrated relaxation pressure (IRP) is predictive of esophageal bolus transit. Methods: Twenty-two dysphagia patients with normal EGJ relaxation were examined with a 36-channel HRM assembly. Each of the ten examinations was performed with 20 mmHg and 30 mmHg pressure topography isobaric contours and findings were categorized based on the Chicago classification. We analyzed the relationships between peristalsis pattern and the discrepancy between IBP and IRP. Results: Twenty-two patients were classified by the Chicago classification; one patient with normal EGJ relaxation and normal peristalsis, eight patients with intermittent hypotensive peristalsis, and thirteen patients with frequent hypotensive peristalsis. A total of 220 individual swallows were analyzed. There were no statistically significant relationships between peristalsis pattern and the discrepancy between IBP and IRP in the 20 mmHg and 30 mmHg isobaric contours. Conclusions: We hypothesized that when IBP overcomes IRP, bolus transit may occur. However, the discrepancy between IBP and IRP was not associated with peristalsis pattern. We need to determine another way to evaluate bolus transit such as the impedance method.

Background:HREPT has positioned as the most accurate technique for identifying esophageal motility disorders (EMD). A new classification, the Chicago Classification (CC), has been proposed to diagnose EMD. The CC parameters were obtained using a solid state high resolution manometry (HRM) system. There are no studies comparing HREPT parameters obtained with solid state and water-perfused systems. Aim: To compare the HREPT metrics between a solid state versus a water-perfused system in asymptomatic volunteers. Subjects and Methods: Asymptomatic volunteers underwent 2 HRM. The first HRM was performed using a solid state catheter with 36 pressure sensors and Manoview 2.0 analysis program (Given Imaging, Shackleford, Duluth USA). One week after, the second HRM was performed using a water-perfused catheter with 22 channels and database Inc. MMS program (Enschede, The Netherlands). All subjects underwent HRM after a 6 h fasting period, in a supine position. Ten liquid swallows with 5 cc of water every 30 seconds were administered. UES pressure, distal contractile integral (DCI), contractile front velocity (CFV), LES basal pressure and integrated relaxation pressure (IRP) were analysed. Nonparametric statistics were used to summarize the data and a Wilcoxon signed-rank test was used for comparison between the 2 HRM systems. Results. Twenty asymptomatic volunteers, 14 women, mean age 34 (24-55 )years. The HREPT metrics with the solid state and water-perfused system are depicted in the table. Conclusions. HREPT metrics: UESp, DCI, CFV, LESp and IRP were significantly lower when the HRM was performed with a water-perfused system. These findings must be considered when CC is used to classify EMD with HRM water-perfused system. HREPT metrics: solid state versus water-perfused systems

Sa1190 Esophagogastric Junction (EGJ) Distensibility Measured by Endoflip™ Before and After Treatment in Achalasia - a Pilot Study Annemijn de Ruigh, Frédéric Nicodème, Yinglian Xiao, John E. Pandolfino, Peter J. Kahrilas Background: Although the pathophysiology of achalasia is associated with both absent peristalsis and impaired lower esophageal sphincter (LES) relaxation, treatment is focused on improving esophageal emptying by disrupting the LES and improving esophagogastric junction (EGJ) distensibility. A new technique, the functional lumen imaging probe (EndoFLIP™), has been developed to measure EGJ opening dimensions during controlled volume distention. The aim of this pilot study was to assess the change in EGJ distensibility in achalasia patients before and after treatment. Methods: Six patients (41 age ± 17.0 yrs, M6) with non-spastic achalasia (Chicago Classification type I=3, II=3) underwent EndoFLIP before and after treatment [Pneumatic Dilation (PD, n=3), Laparoscopic Heller Myotomy (LHM, n=1) and Peroral Endoscopic Myotomy (POEM, n=2)]. Patients also underwent high resolution manometry (HRM) and assessment with validated questionnaires to determine the Eckardt Score (ES) before and after treatment. EndoFLIP™ measurement of EGJ distensibility (EGJ-DI) was performed by measuring simultaneous cross sectional area (CSA) and luminal distention pressure during 20, 30 and 40 ml distention and was defined as narrowest EGJ CSA (mm2)/intra-bag pressure (mmHg). Results: The EGJ distensibility index improved after treatment in 5 of 6 patients (Figure 1) and there was a statistically significant increase in the mean EGJ-DI at the 30 ml distention volume (p<0.05). Four patients had symptom improvement (mean reduction in ES of 3.5). Of these, 3 patients normalized their IRP to less than 15 mmHg with one patient having a borderline IRP of 17 mmHg. All four patients with symptom improvement had an increase in their EGJ-DI at 30 ml. Two patients were still symptomatic after treatment (post-treatment ES: 6, 8) and their EGJ-DI at 30 ml did not increase significantly. Although one post-treatment symptomatic patients had an IRP of 48 mmHg, the other had a normal post-treatment IRP (10.5 mmHg) despite exhibiting a 50% reduction in the EGJ-DI at 30 ml. Conclusion: EGJ-DI appears to be a useful measure to assess post-treatment efficacy of achalasia treatments focused on disrupting the LES. The EGJ-DI appears to quantify a distinct physiological property of the EGJ compared to HRM as evidenced by one patient with an adequate response to treatment based on IRP, but worsening in terms of the EGJ-DI. Thus, the measurement of EGJ distensibility may provide an additional clinical tool for assessing the adequacy of sphincter disrupting treatments in the management of achalasia.

*p<0.05 Sa1192 The Utility of Barium Swallow for Assessment of the Adults Operated on for Esophageal Atresia Valérie Huynh-Trudeau, Sophie Grand'Maison, Stéphanie Maynard, Mickael Bouin Introduction: Esophageal atresia is the most common congenital anomaly of the esophagus. It affects one in every 3000 live births and justifies a surgical intervention in the first days of life. Although the survival rate is over 90%, when these patients become adults, they tend to have a high prevalence of dysphagia, for which the causes are unknown. Our hypothesis is that esophageal anatomic anomalies could explain the esophageal symptoms of these adults. The aim of this study is to describe the esophageal anatomic anomalies of adults previously operated on for esophageal atresia. Method: This study was conducted in the motility laboratory of St-Luc Hospital between 2008 and 2011. All patients who had been operated on for esophageal atresia and followed in the clinic were eligible. All patient participants in this study had a clinical examination, a standard symptom questionnaire and a barium swallow. Results: Of 41 patients followed in the clinic, 29 who accepted barium swallow were included (mean age: 25 ± 7 years, mean BMI: 23 ± 5, 59% male). The barium swallow was abnormal in 45% (n=13). The anomalies found were: 1) dilatation in 28% (n= 8, 4 upstream of the anastomosis and 3 downstream), 2) delay in esophageal emptying in 14% (n=4, 2 associated with aperistalsis in the inferior esophagus, 1 with a ileo-colic transposition, 1 with a dilatation), 3) diverticula in 14% (n=4; 1 at the anastomosis level, 3 in the inferior esophagus) and 4) stenosis in 7% (n=2, 1 in the proximal esophagus associated with a dilatation and 1 at the esophago-colic junction of a ileo-colic transposition). There was more than one anomaly in 14% (n=4). Dysphagia occurred in 48%. Anatomical anomalies on the barium swallow were more frequent in patients with dysphagia than in patients without dysphagia, even though this result was not statistically significant (64% vs 27%; p=0.07). Conclusion: This study is the first to demonstrate that esophageal anatomical

*P<0.05, Paired t-test

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AGA Abstracts