Utility of the Endoscopic Pressure Study Integrated System in Identifying Silent Gastroesophageal Reflux Disease During Routine Health Check-ups

Abstract

Objectives

The endoscopic pressure study integrated system (EPSIS) is a novel functional endoscopic modality that records intragastric pressure (IGP) waveforms during CO₂ insufflation to evaluate lower esophageal sphincter (LES) function and diagnose gastroesophageal reflux disease (GERD). Although previous studies have applied EPSIS to symptomatic patients, its utility in asymptomatic individuals remains unclear. This study aimed to evaluate the diagnostic value of EPSIS in detecting silent GERD—defined as asymptomatic erosive esophagitis—and associated risk factors in individuals undergoing routine health check-ups.

Methods

We retrospectively analyzed 185 participants who underwent esophagogastroduodenoscopy (EGD) and EPSIS as part of routine health check-ups at a single center between November 2024 and March 2025. Participants were classified into erosive and non-erosive groups based on the presence or absence of mucosal breaks (Grade A or higher) according to the Los Angeles classification. Background characteristics, EPSIS parameters, and endoscopic findings were compared.

Results

EPSIS was safely performed in all participants without adverse events. The erosive esophagitis group showed significantly more flat waveform patterns (39.4% vs. 14.5%, p = 0.002) and lower maximum IGP values (16.7 mmHg vs. 18.3 mmHg, p = 0.008) compared to the non-erosive group.

Conclusion

EPSIS enables a safe and objective assessment of LES function and may support the identification of erosive esophagitis in asymptomatic individuals. It may hold promise as a functional diagnostic tool for the detection of silent GERD and may support preventive strategies during routine endoscopy.