Enhancing the utility of antroduodenal manometry in pediatric intestinal pseudo‐obstruction. Issue 5 (16th September 2021)

• Record Type: Journal Article
• Authors: Chanpong, Atchariya; Cronin, Hannah; Rampling, Dyanne; Ashworth, Michael; Eaton, Simon; Rybak, Anna; Saliakellis, Efstratios; Lindley, Keith J.; Borrelli, Osvaldo; Thapar, Nikhil
• Is Part Of: Neurogastroenterology & motility. Volume 34:Issue 5(2022)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-09-16
• Subjects: antroduodenal manometry -- gastrointestinal motility -- histopathology -- intestinal pseudo‐obstruction -- pediatric -- scoring system -- small intestine; Gastrointestinal system -- Motility -- Periodicals; Gastrointestinal system -- Innervation -- Periodicals; 616.33
• DOI: 10.1111/nmo.14259
• Languages: English
• ISSNs: 1350-1925

Abstract

Abstract: Background: Antroduodenal manometry (ADM) and histopathology are currently employed to aid the diagnosis of pediatric intestinal pseudo‐obstruction (PIPO). Limited data are available on the reliability of ADM analysis and its correlation with histopathology. We aimed to develop a protocol for enhanced analysis of ADM contractile patterns, including a scoring system, and explore whether this provided better correlation with histopathology. Methods: Children referred with suspected PIPO between April 2012‐December 2019 who underwent both ADM and full‐thickness biopsies were included. ADM tracings were analyzed using both standard (conventional ADM) and novel (enhanced ADM) motility parameters. A novel ADM score (GLASS score) was generated based on the enhanced ADM analysis. Conventional and enhanced ADM analyses were then correlated with histopathology. Results: Forty patients were included. Using conventional clinical criteria, 29 of these were diagnosed with PIPO and the other 11 with non‐PIPO diagnoses. Twenty‐three of the PIPO patients had abnormal histopathology: 6 myopathy, 4 neuropathy, 3 neuro‐myopathy, and 10 non‐specific changes. No agreement in diagnosis was found between conventional ADM analysis and histopathology (ϰ = 0.068; p = 0.197), whereas the latter significantly correlated with enhanced ADM analysis (ϰ = 0.191; p = 0.003). The enhanced ADM score was significantly higher in PIPO versus non‐PIPO (16.0 vs. 8.0; p < 0.001). Conclusions: As opposed to conventional analysis protocols, the newly developed enhanced ADM analysis and associated score is not only able to discriminate between PIPO and non‐PIPO patients, but also between distinct histopathological pathologies. Further studies are required to assess the utility of enhanced ADM analysis in larger populations. Abstract : Enhanced analysis of Antroduodenal Manometry (ADM) and the generated numerical (GLASS) score not only has utility in the definitive diagnosis of Paediatric Intestinal Pseudo‐obstruction but also provides better correlation with histopathology compared to conventional ADM analysis.