High-resolution manometry is superior to endoscopy and radiology in assessing and grading sliding hiatal hernia: A comparison with surgical in vivo evaluation. Issue 7 (August 2018)

• Record Type: Journal Article
• Authors: Tolone, Salvatore; Savarino, Edoardo; Zaninotto, Giovanni; Gyawali, C Prakash; Frazzoni, Marzio; de Bortoli, Nicola; Frazzoni, Leonardo; del Genio, Gianmattia; Bodini, Giorgia; Furnari, Manuele; Savarino, Vincenzo; Docimo, Ludovico
• Is Part Of: United European Gastroenterology journal. Volume 6:Issue 7(2018)
• Page Start: 981
• Page End: 989
• Publication Date: 2018-08
• Subjects: Hiatal hernia -- esophagogastric junction -- high resolution manometry -- upper endoscopy -- barium esophagogram; Gastroenterology -- Periodicals; Periodicals; 616.33005
• DOI: 10.1177/2050640618769160
• Languages: English
• ISSNs: 2050-6406

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.