Utility of endoscopic pressure study integrated system for gastroesophageal reflux disease after endoscopic antireflux therapy

Objectives

The endoscopic pressure study integrated system (EPSIS) measures intragastric pressure (IGP) during esophagogastroduodenoscopy. Previous research demonstrated that EPSIS correlates with the 24-h impedance-pH (MII-pH) test and shows lower maximum IGP (IGP-Max) and a flatter waveform gradient in gastroesophageal reflux disease (GERD) patients, attributed to lower esophageal sphincter dysfunction. Although endoscopic antireflux therapy (EARTh) is effective for GERD, the MII-pH monitoring, the gold standard for assessing treatment outcomes, requires hospitalization and can be a burden. EPSIS offers a noninvasive alternative for evaluating post-EARTh outcomes. This study aimed to assess EPSIS as an additional diagnostic tool in this context.

Methods

We conducted a retrospective analysis of GERD patients who underwent EARTh and were subsequently assessed using EPSIS within 6 months, from May 2018 to April 2024. Changes in IGP parameters, including IGP-Max and waveform gradient, were analyzed pre- and post-EARTh. Additionally, the study examined Hill's Classification following EARTh.

Results

Out of 39 patients assessed with EPSIS before and after EARTh, the average age was 55 years (standard deviation [SD] 16.7), with 64.1% male. Postoperative IGP-Max increased from 15.2 mmHg to 18.0 mmHg (P = 0.004), and the pressure gradient improved from 0.16 mmHg/s to 0.28 mmHg/s (P < 0.001). Hill's Classification improved significantly from a mean of 2.2 (SD 0.7) to 1.1 (SD 0.3) (P < 0.001).

Conclusion

This study indicates that EPSIS is a reliable diagnostic tool for evaluating the effects of EARTh and holds potential as a supplementary tool for assessing GERD treatment outcomes.