OA09.3. Manometry-Only Distensibility Assessment: Inverted-Impedance 4D Manometry for Detecting Distension-Mediated Obstruction When the Functional Lumen Imaging Probe Is Unavailable

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ID: 325898
2026
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Abstract
Abstract Topic Benign Disease: Esophageal Function and Motility Background Distension-mediated obstruction (DMO) denotes normal or ineffective motility on high-resolution manometry but impaired esophagogastric junction opening on functional lumen imaging probe (EGJ-DI <2.0 mm2/mmHg; diameter <12 mm). Inverted-impedance 4D manometry estimates distensibility from conductance reflecting luminal area. We evaluated discrimination of FLIP-confirmed DMO and feasibility as an alternative. Methods Healthy volunteers were prospectively enrolled after Rome IV screening. Patients with FLIP-confirmed DMO (EGJ-DI < 2.0 mm2/mmHg and diameter < 12 mm) who also underwent HRIM at a tertiary center were included. HRIM was performed according to the Chicago Classification v4.0 protocol. For each subject, pressure–impedance data from the first five supine swallows were exported in ASCII format and processed using a custom MATLAB pipeline consisting of: (1) baseline correction, (2) inversion of impedance to conductance, (3) integration of EGJ conductance across channels within the analysis window, (4) normalization by intrabolus pressure, and (5) extraction of the median value as the conductance-based distensibility metric (VII-DI) (Figure 1). ROC analysis was performed to evaluate the diagnostic performance of VII-DI. Results Ten healthy controls (mean age 30.7 ± 8.7 years) and seven patients with FLIP-confirmed DMO (mean age 58.3 ± 9.8 years; normal motility n=4, IEM n=3) were analyzed. Among DMO patients, FLIP-derived EGJ-DI was 0.56 ± 0.45 mm2/mmHg. VII-DI demonstrated meaningful discrimination between DMO and controls, with an AUC of 0.765 (95% CI, 0.650–0.871; p<0.001) (Figure 2). A threshold of 0.284 mS/mmHg (Youden index) yielded a sensitivity of 0.706 and specificity of 0.840. Conclusion Inverted-impedance 4D manometry enhances discrimination of DMO compared with conventional impedance measures and provides a mechanistically grounded surrogate for impaired EGJ opening. This manometry-only distensibility assessment shows promise as a practical alternative in settings where FLIP is unavailable, potentially broadening diagnostic capabilities for DMO. These pilot data support further multicenter validation of VII-DI as a scalable physiological tool for evaluating EGJ opening.
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Authors So Young Byun, Kee Wook Jung
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Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.061
URL
https://academic.oup.com/dote/article-pdf/39/Supplement_1/doag077.061/70760785/doag077.061.pdf
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