Salvatore Tolone1, Edoardo Savarino2, Giovanni Zaninotto3, C Prakash Gyawali4, Marzio Frazzoni5, Nicola de Bortoli6, Leonardo Frazzoni7, Gianmattia Del Genio1, Giorgia Bodini8, Manuele Furnari8, Vincenzo Savarino8, Ludovico Docimo1. 1. Department of Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy. 2. Department of Gastroenterology, University of Padua, Padua, Italy. 3. Department of Surgery, Imperial College, London, UK. 4. Department of Gastroenterology, Washington University School of Medicine, St Louis, USA. 5. Department of Gastroenterology, Baggiovara Hospital, Modena, Italy. 6. Department of Gastroenterology, University of Pisa, Pisa, Italy. 7. Department of Gastroenterology, University of Bologna, Bologna, Italy. 8. Department of Gastroenterology, University of Genoa, Genoa, Italy.
Abstract
BACKGROUND: Hiatal hernia is diagnosed by barium-swallow esophagogram or esophagogastroduodenoscopy, with possible suboptimal results. High-resolution manometry clearly identifies crural diaphragm and lower esophageal sphincter. OBJECTIVES: To assess the diagnostic accuracy of high-resolution manometry in detecting hiatal hernia compared to esophagogram and esophagogastroduodenoscopy, using as reference the surgical in vivo measurement. METHODS: Patients were studied with esophagogram, esophagogastroduodenoscopy, high-resolution manometry and in vivo evaluation of the esophago-gastric junction. Esophago-gastric junction was classified as type I (no separation between crural diaphragm and lower esophageal sphincter); type II (≥1, ≤ 2 cm separation); type III (>2 cm). During in vivo measurement, distance between the esophago-gastric junction and crural diaphragm proximal border was recorded. RESULTS: Surgery identified 53 hiatal hernias in 100 patients. Forty-seven percent were classified as type I esophago-gastric junction, 35% type II and 18% type III. Referenced to in vivo evaluation, high-resolution manometry showed superior diagnostic sensitivity and specificity (94.3% and 91.5%, respectively) to esophagogram and esophagogastroduodenoscopy, with 92.6% predictive value of a positive test and 93.5% predictive value of a negative test. The kappa value for high-resolution manometry and in vivo evaluation was 0.85. High-resolution manometry showed optimal sensitivity and specificity in detecting types I, II and III esophago-gastric junction. CONCLUSIONS: High-resolution manometry enables an accurate diagnosis of hiatal hernia and a better classification than endoscopy and radiology, reaching optimal agreement with in vivo assessment.
BACKGROUND: Hiatal hernia is diagnosed by barium-swallow esophagogram or esophagogastroduodenoscopy, with possible suboptimal results. High-resolution manometry clearly identifies crural diaphragm and lower esophageal sphincter. OBJECTIVES: To assess the diagnostic accuracy of high-resolution manometry in detecting hiatal hernia compared to esophagogram and esophagogastroduodenoscopy, using as reference the surgical in vivo measurement. METHODS: Patients were studied with esophagogram, esophagogastroduodenoscopy, high-resolution manometry and in vivo evaluation of the esophago-gastric junction. Esophago-gastric junction was classified as type I (no separation between crural diaphragm and lower esophageal sphincter); type II (≥1, ≤ 2 cm separation); type III (>2 cm). During in vivo measurement, distance between the esophago-gastric junction and crural diaphragm proximal border was recorded. RESULTS: Surgery identified 53 hiatal hernias in 100 patients. Forty-seven percent were classified as type I esophago-gastric junction, 35% type II and 18% type III. Referenced to in vivo evaluation, high-resolution manometry showed superior diagnostic sensitivity and specificity (94.3% and 91.5%, respectively) to esophagogram and esophagogastroduodenoscopy, with 92.6% predictive value of a positive test and 93.5% predictive value of a negative test. The kappa value for high-resolution manometry and in vivo evaluation was 0.85. High-resolution manometry showed optimal sensitivity and specificity in detecting types I, II and III esophago-gastric junction. CONCLUSIONS: High-resolution manometry enables an accurate diagnosis of hiatal hernia and a better classification than endoscopy and radiology, reaching optimal agreement with in vivo assessment.
Authors: E Savarino; L Gemignani; D Pohl; P Zentilin; P Dulbecco; L Assandri; E Marabotto; D Bonfanti; S Inferrera; V Fazio; A Malesci; R Tutuian; V Savarino Journal: Aliment Pharmacol Ther Date: 2011-06-14 Impact factor: 8.171
Authors: Edoardo Savarino; Radu Tutuian; Patrizia Zentilin; Pietro Dulbecco; Daniel Pohl; Elisa Marabotto; Andrea Parodi; Giorgio Sammito; Lorenzo Gemignani; Giorgia Bodini; Vincenzo Savarino Journal: Am J Gastroenterol Date: 2009-12-08 Impact factor: 10.864
Authors: C Prakash Gyawali; Dustin A Carlson; Joan W Chen; Amit Patel; Robert J Wong; Rena H Yadlapati Journal: Am J Gastroenterol Date: 2020-09 Impact factor: 12.045
Authors: Wenjun Kou; Dustin A Carlson; Alexandra J Baumann; Erica N Donnan; Jacob M Schauer; Mozziyar Etemadi; John E Pandolfino Journal: Artif Intell Med Date: 2021-12-25 Impact factor: 5.326
Authors: Peter J Kahrilas; Ravinder K Mittal; Serhat Bor; Geoffrey P Kohn; Johannes Lenglinger; Sumeet K Mittal; John E Pandolfino; Jordi Serra; Roger Tatum; Rena Yadlapati Journal: Neurogastroenterol Motil Date: 2021-03-02 Impact factor: 3.960