Anika Vela, , Fangfang Wang, MD, Michael Crowell, PhD, Marcelo Vela, MD, Francisco C.. Ramirez, MD, MACG Mayo Clinic, Scottsdale, AZ Introduction: High Resolution Manometry (HRM) is the gold standard to diagnose esophageal motility disorders. Barium esophagram (BE), often used to evaluate dysphagia or other esophageal symptoms, routinely includes esophageal motility assessment.
There are limited data evaluating the accuracy ofBE to assess esophageal motility. The very few available studies used outdated HRM analysis paradigms and showed discordance between BE and HRM findings, suggesting that the BE may not be adequate for diagnosing esophageal dysmotility.
Our aim was to determine whether BE is reliable for esophageal motility assessment, compared to the current gold standard of HRM analyzed by Chicago Classification version 4.0 (CCv4.0). Methods: Retrospective analysis of adult patients that underwent BE and HRM within a 12-month interval. Patients with a history of fundoplication were excluded. Esophagram was performed with standard technique, and esophageal motility was reported as normal or abnormal. HRM was performed and analyzed following CCv4.0 protocol and reported as normal or abnormal.
Concordance, sensitivity, specificity, and area under the curve (AUC) were calculated for esophagram, with HRM diagnosis as the gold standard. Results: 120 patients were included, 81 (67%) female, mean age = 64 years, mean Body Mass Index = 27. Normal esophageal motility was found in 60 (50%) patients by HRM and 32 (27%) patients by BE. Concordance between BE and HRM was poor; the concordance correlation coefficient was 0.26, with a 95% confidence interval [0.1, 0.4]. Compared to HRM, BE had 86% sensitivity and 40% specificity for diagnosing esophageal dysmotility; the Receiver Operating Characteristic (ROC) curve showed an Area Under the Curve (AUC) score of 0.6 (Figure 1). BE had a positive predictive Value of 59%, and a negative predictive value of 75%. Discussion: Our results showed poor concordance between BE and HRM. BE had reasonable sensitivity but very low specificity to detect esophageal dysmotility, indicating a high rate of false positive results for dysmotility by BE. Furthermore, the AUC value indicates poor discrimination, and thus limited ability to distinguish correctly between patients with and without esophageal motility disorders.
Based on these results, BE should not be used to assess esophageal motility.
Figure: Figure 1. Receiver Operating Characteristic Curve for Esophagram-Based Assessment of Esophageal Motility.
AUC: Area Under the Curve
Figure: Figure 1. Receiver Operating Characteristic Curve for Esophagram-Based Assessment of Esophageal Motility.
AUC: Area Under the Curve
Disclosures: Anika Vela indicated no relevant financial relationships. Fangfang Wang indicated no relevant financial relationships. Michael Crowell indicated no relevant financial relationships. Marcelo Vela: Medtronic – Consultant. Francisco Ramirez indicated no relevant financial relationships.
Anika Vela, , Fangfang Wang, MD, Michael Crowell, PhD, Marcelo Vela, MD, Francisco C.. Ramirez, MD, MACG. P4956 - Diagnostic Yield of Esophagram Compared to Gold Standard Esophageal Manometry for Detection of Esophageal Motility Abnormalities, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
