OA09.2. Inverted Impedance–Based 4D Manometry Improves Achalasia Diagnosis by Assessing Esophagogastric Junction Distensibility When Functional Lumen Imaging Probe Is Unavailable

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ID: 325696
2026
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Ranked #134 of 453 articles by views in diseases of the esophagus : official journal of the international society for diseases of the esophagus

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Abstract
Abstract Topic Benign Disease: Esophageal Function and Motility Background Achalasia remains difficult to diagnose, and the functional lumen imaging probe (FLIP) is the reference standard for assessing esophagogastric junction opening. Inverted impedance–based 4D manometry estimates EGJ distensibility via conductance related to luminal area. We evaluated its ability to distinguish achalasia from controls and substitute for FLIP when unavailable. Methods Healthy volunteers were prospectively enrolled after Rome IV screening. Patients with achalasia (types I–III) who underwent both high-resolution impedance manometry (HRIM) and FLIP at a tertiary center were included. HRIM studies followed the Chicago Classification v4.0 protocol. Pressure–impedance recordings from the first five supine swallows were exported in ASCII format and processed using a custom MATLAB pipeline comprising baseline correction, inversion of impedance to conductance, integration of luminal conductance over time and along the EGJ, and normalization by intrabolus pressure to calculate the inverted-impedance EGJ distensibility index (VII-DI) (Figure 1). Diagnostic accuracy was assessed using receiver operating characteristic (ROC) analysis. Results Ten healthy participants (median age 29) and 31 patients with achalasia (median age 59; type I: n=11, type II: n=10, type III: n=10) were analyzed. The mean FLIP-derived EGJ-DI among achalasia patients was 0.9 ± 0.6 mm2/mmHg. VII-DI demonstrated good overall diagnostic performance, with an AUC of 0.817 (95% CI: 0.732–0.904; p<0.001), sensitivity of 0.710, and specificity of 0.880 for identifying achalasia (Figure 2). A threshold of 0.307 mS/mmHg (Youden index) yielded a sensitivity of 0.710 and specificity of 0.880.Subgroup analysis showed the highest discrimination for type I (AUC 0.919), followed by type III (0.821) and type II (0.700). Conclusion Inverted-impedance 4D manometry provides robust diagnostic discrimination and shows strong concordance with FLIP-derived EGJ distensibility. Because conductance increases proportionally with luminal opening, VII-DI offers a physiologically meaningful surrogate for assessing EGJ distensibility. This manometry-only approach may be particularly useful in centers lacking access to FLIP and has the potential to broaden diagnostic capabilities for achalasia. These findings support VII-DI as a scalable, technically reliable, and clinically relevant metric for evaluating EGJ opening when FLIP is unavailable.
Reference Key
openalex_W7203910190 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors So Young Byun, Kee Wook Jung
Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.060
URL
https://doi.org/10.1093/dote/doag077.060
Keywords Keywords not found

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