Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug 1;118(8):1334-1343.
doi: 10.14309/ajg.0000000000002285. Epub 2023 Apr 11.

Interrater Reliability of Functional Lumen Imaging Probe Panometry and High-Resolution Manometry for the Assessment of Esophageal Motility Disorders

Joan W Chen  1 , Abraham Khan  2 , Reena V Chokshi  3 , John O Clarke  4 , Ronnie Fass  5 , Jose M Garza  6 , Milli Gupta  7 , C Prakash Gyawali  8 , Anand S Jain  9 , Philip Katz  10 , Vani Konda  11 , Adriana Lazarescu  12 , Kristle L Lynch  13 , Felice Schnoll-Sussman  10 , Stuart J Spechler  11 , Marcelo F Vela  14 , Rena Yadlapati  15 , Jacob M Schauer  16 , Peter J Kahrilas  17 , John E Pandolfino  17 , Dustin A Carlson  17
Affiliations

Interrater Reliability of Functional Lumen Imaging Probe Panometry and High-Resolution Manometry for the Assessment of Esophageal Motility Disorders

Joan W Chen et al. Am J Gastroenterol. .

Abstract

Introduction: High-resolution manometry (HRM) and functional lumen imaging probe (FLIP) are primary and/or complementary diagnostic tools for the evaluation of esophageal motility. We aimed to assess the interrater agreement and accuracy of HRM and FLIP interpretations.

Methods: Esophageal motility specialists from multiple institutions completed the interpretation of 40 consecutive HRM and 40 FLIP studies. Interrater agreement was assessed using intraclass correlation coefficient (ICC) for continuous variables and Fleiss' κ statistics for nominal variables. Accuracies of rater interpretation were assessed using the consensus of 3 experienced raters as the reference standard.

Results: Fifteen raters completed the HRM and FLIP studies. An excellent interrater agreement was seen in supine median integral relaxation pressure (ICC 0.96, 95% confidence interval 0.95-0.98), and a good agreement was seen with the assessment of esophagogastric junction (EGJ) outflow, peristalsis, and assignment of a Chicago Classification version 4.0 diagnosis using HRM (κ = 0.71, 0.75, and 0.70, respectively). An excellent interrater agreement for EGJ distensibility index and maximum diameter (0.91 [0.90-0.94], 0.92 [0.89-0.95]) was seen, and a moderate-to-good agreement was seen in the assignment of EGJ opening classification, contractile response pattern, and motility classification (κ = 0.68, 0.56, and 0.59, respectively) on FLIP. Rater accuracy for Chicago Classification version 4.0 diagnosis on HRM was 82% (95% confidence interval 78%-84%) and for motility diagnosis on FLIP Panometry was 78% (95% confidence interval 72%-81%).

Discussion: Our study demonstrates high levels of interrater agreement and accuracy in the interpretation of HRM and FLIP metrics and moderate-to-high levels for motility classification in FLIP, supporting the use of these approaches for primary or complementary evaluation of esophageal motility disorders.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.. Study scheme.
Same HRMa or same FLIPb studies.
Figure 2
Figure 2
Examples of individual HRM and FLIP studies with rater diagnostic patterns. A) shows an HRM study that was interpreted as type III achalasia by majority of raters, while a minority interpreted it as type II achalasia (reference diagnosis: type III achalasia). B) was an HRM study with high rater discrepancy where about half the raters interpreted the study as type II achalasia, and the other half interpreted as type I, EGJ outflow obstruction, IEM, and absent contractility (reference diagnosis: EGJOO). In panel C), majority of raters interpreted the FLIP study as spastic-reactive, while the others interpreted it as obstruction with weak contractile response and inconclusive (reference diagnosis: spastic reactive). Majority of raters interpreted the FLIP study in panel D) as spastic reactive, while a minority interpreted as normal (reference diagnosis: normal).
Figure 2
Figure 2
Examples of individual HRM and FLIP studies with rater diagnostic patterns. A) shows an HRM study that was interpreted as type III achalasia by majority of raters, while a minority interpreted it as type II achalasia (reference diagnosis: type III achalasia). B) was an HRM study with high rater discrepancy where about half the raters interpreted the study as type II achalasia, and the other half interpreted as type I, EGJ outflow obstruction, IEM, and absent contractility (reference diagnosis: EGJOO). In panel C), majority of raters interpreted the FLIP study as spastic-reactive, while the others interpreted it as obstruction with weak contractile response and inconclusive (reference diagnosis: spastic reactive). Majority of raters interpreted the FLIP study in panel D) as spastic reactive, while a minority interpreted as normal (reference diagnosis: normal).
Figure 3
Figure 3
Management decision based on diagnosis. A) shows management decision by the raters based on HRM diagnosis and B) shows management decision by raters based on FLIP diagnosis. Ach, achalasia; EGJOO, esophagogastric outflow obstruction; IEM, ineffective esophageal motility; PPI, proton pump inhibitor; CBT, cognitive behavioral therapy; SMR, systemic muscle relaxant; PD, pneumatic dilation; POEM, peroral endoscopic myotomy; LHM, laparoscopic Heller myotomy; CR, contractile response
Figure 3
Figure 3
Management decision based on diagnosis. A) shows management decision by the raters based on HRM diagnosis and B) shows management decision by raters based on FLIP diagnosis. Ach, achalasia; EGJOO, esophagogastric outflow obstruction; IEM, ineffective esophageal motility; PPI, proton pump inhibitor; CBT, cognitive behavioral therapy; SMR, systemic muscle relaxant; PD, pneumatic dilation; POEM, peroral endoscopic myotomy; LHM, laparoscopic Heller myotomy; CR, contractile response
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Bredenoord AJ, Fox M, Kahrilas PJ, Pandolfino JE, Schwizer W, Smout AJ, et al. Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography. Neurogastroenterol Motil. 2012;24 Suppl 1:57–65. - PMC - PubMed
    1. Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, et al. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27(2):160–74. - PMC - PubMed
    1. Pandolfino JE, Fox MR, Bredenoord AJ, Kahrilas PJ. High-resolution manometry in clinical practice: utilizing pressure topography to classify oesophageal motility abnormalities. Neurogastroenterol Motil. 2009;21(8):796–806. - PMC - PubMed
    1. Yadlapati R, Kahrilas PJ, Fox MR, Bredenoord AJ, Prakash Gyawali C, Roman S, et al. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0((c)). Neurogastroenterol Motil. 2021;33(1):e14058. - PMC - PubMed
    1. Soudagar AS, Sayuk GS, Gyawali CP. Learners favour high resolution oesophageal manometry with better diagnostic accuracy over conventional line tracings. Gut. 2012;61(6):798–803. - PMC - PubMed

Publication types

MeSH terms