Esophagogastric junction outflow obstruction on manometry: Outcomes and lack of benefit from CT and EUS. Issue 12 (15th September 2019)

• Record Type: Journal Article
• Authors: Liu, Andy; Woo, Matthew; Nasser, Yasmin; Gupta, Milli; Buresi, Michelle C.; Curley, Michael; Li, Dorothy Y.; Wilsack, Lynn; Andrews, Christopher N.
• Is Part Of: Neurogastroenterology & motility. Volume 31:Issue 12(2019)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2019-09-15
• Subjects: esophagogastric junction outflow obstruction -- high‐resolution manometry; Gastrointestinal system -- Motility -- Periodicals; Gastrointestinal system -- Innervation -- Periodicals; 616.33
• DOI: 10.1111/nmo.13712
• Languages: English
• ISSNs: 1350-1925

Abstract

Abstract: Background: Esophagogastric junction outflow obstruction (EGJOO) is a manometric diagnosis based on the Chicago Classification defined by inadequate relaxation of the gastroesophageal junction (GEJ) with swallowing, but with sufficient peristalsis such that the criteria for achalasia are not met. Possible causes include anatomical and functional etiologies. Further investigations, including computed tomography (CT) of the chest and endoscopic ultrasound (EUS), to help elucidate the etiology of EGJOO have been suggested, but the utility of this approach has not been proven. Methods: All new diagnoses of EGJOO made in the calendar years 2015‐2016 were included. A review was performed for each patient to assess clinical outcomes, diagnostic, and therapeutic interventions after the EGJOO diagnosis. Key Results: 107 EGJOO patients were included. Their primary complaints were dysphagia (68%), chest pain (12%), reflux (8%), pre‐operative assessment (6%), regurgitation (3%), and cough (3%). The mean IRP was 21.8 mm Hg. After a mean follow‐up period of 463 days, the etiology of EGJOO remained undetermined in 67% of patients. 48% of patients were investigated with cross‐sectional imaging (and 10% with EUS to rule out external compression or malignancy as a cause of EGJOO; none of these tests provided any further useful information). In only two cases did the EGJOO progress to achalasia. Conclusions & Inferences: EGJOO is a manometric diagnosis with unclear clinical significance and outcome. CT and EUS of the GEJ were unhelpful at determining the cause of this entity. In this series, very few appear to progress to achalasia, none were due to malignancy, and many resolved spontaneously. Abstract : CT and EUS of the GEJ were unhelpful at determining the cause of EGJOO, as they only revealed non‐specific findings or findings that could be seen readily with EGD or BE. Our study may support the reconsideration of the current suggestion that CT and EUS be ordered for all EGJOO.