2021 TDDW
Special Lecture (VI) CLINICAL APPLICATION OF HIGH RESOLUTION ESOPHAGEAL MANOMETRY: WHAT IS NEW IN CHICAGO 4.0 John Pandolfino President, American Neurogastroenterology and Motility Society Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA The goal of any diagnostic scheme is to objectively classify patients with similar symptoms into appropriate clinical categories that ultimately direct specific therapies. Classification schemes for esophageal motility disorders were developed initially using conventional manometry which displayed the data in a line tracing format. While conventional manometry set the basis for the diagnosis of esophageal motility disorders, the large axial spacing between recording sites leaves large portions of the esophagus unevaluated and vulnerable to movement artifact. On the other hand, the continuous spatiotemporal representations of pressure through the entire esophagus recorded with high resolution manometry offers greater detail and improved accuracy for many of the most important measurements of esophageal motor function. This technology has evolved into the Chicago Classification 4.0, which was
recently updated to assess the restrictive protocol and flaws around defining disease based on the integrated relaxation pressure (IRP). The addition of upright position and provocative swallows can help clarify borderline cases and the use of esophagram and FLIP can help provide a conclusive diagnosis of obstruction. Last, the criteria for ineffective esophageal motility was also revised to provide a grouping that has a higher level of clinical significance. A more recent evolution of manometric technique, FLIP Panometry will also be discussed during this lecture as it represents a new modality that leverages an assessment of secondary peristalsis to classify motility disorders. The unique application of this approach during the initial endoscopy provides a more efficient screening assessment for disease and may also describe variants not explained by manometry.
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