Virali Shah, MBA1, Alexandra Mignucci, MS1, Micheal Tadros, MD, MPH, FACG2 1Albany Medical Center, Albany, NY; 2Albany Medical College, Albany, NY
Introduction: Diagnosing IEM disorders involves HRM and provocative tests, such as multiple rapid swallows (MRS), apple viscous swallows (AVS), and wet swallows (WS). Peristaltic reserve, percentage of ineffective and failed swallows, and impedance clearance are used as indicators of IEM disorders. This study determines if AVS and impedance clearance serve as beneficial tests to complement MRS in detection of IEM and preoperative preparedness.
Methods: In this retrospective study, 100 patients underwent HRM. 86 patients were analyzed for their impedance clearance, AVS, and MRS results. This study was conducted at a tertiary, academic center in Upstate New York. Patients were classified by their Chicago Classification (CC). Incomplete bolus transit for WS and AVS, IEM features from MRS and AVS, and absent peristalsis were measured. Incomplete bolus transit was defined as incomplete impedance clearance (≥ 20% for WS; ≥ 30% for AVS). IEM from MRS was defined as weak peristaltic reserve (DCI ratio< 0.85) or absent peristalsis (100% failed). IEM from AVS was defined as >50% of ineffective contractions or absent peristalsis.
Results: Among the patients with Normal CC, 12 patients (38%) had only incomplete bolus transit, 14 (44%) had only IEM features, and 3 (9%) met both IEM and incomplete bolus transit criteria. In the IEM CC patient group, 1 patient (10%) had only incomplete bolus transit, 2 (20%) had only IEM features, and 7 (70%) had both IEM and incomplete bolus transit. Overall, there was significantly more agreement between the IEM and incomplete bolus transit results in the IEM CC group than in the Normal CC group (9% vs 70%; p< 0.05).
Discussion: This study found special utility of viscous swallows and impedance clearance for assessing IEM. Currently, DCI ratio from MRS guides assessment of IEM. AVS, however, is helpful in eliciting absent peristalsis to indicate a severe degree of dysfunction. AVS detection of absent peristalsis and hypokinetic disorders was crucial for preoperative management. This study also supports the growing value of impedance. 31% of patients with incomplete bolus transit did not present with IEM features on either AVS or MRS, and 90% of patients classified as Normal CC were found to have some degree of IEM. CC guidelines are not thorough for all IEM cases. It is recommended that impedance clearance and IEM features detected by AVS and MRS are assessed together to gain an accurate context of IEM.
Figure: Figure 1. Flowchart demonstrating IEM and absent peristalsis results for MRS alone, AVS alone, and MRS combined with AVS.
Virali Shah indicated no relevant financial relationships.
Alexandra Mignucci indicated no relevant financial relationships.
Micheal Tadros indicated no relevant financial relationships.
Virali Shah, MBA1, Alexandra Mignucci, MS1, Micheal Tadros, MD, MPH, FACG2. P2421 - Viscous Swallows and Impedance Clearance Can Provide Additional Value in Assessing Ineffective Esophageal Motility and Preoperative Preparedness Compared to Multiple Rapid Swallows, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.