High-resolution manometry is superior to endoscopy and radiology in assessing and grading sliding hiatal hernia: A comparison with surgical in vivo evaluation

Abstract

<div class="section"> <a class="named-anchor" id="d8570719e238"> <!-- named anchor --> </a> <h5 class="section-title" id="d8570719e239">Background</h5> <p id="d8570719e241">Hiatal hernia is diagnosed by barium-swallow esophagogram or esophagogastroduodenoscopy, with possible suboptimal results. High-resolution manometry clearly identifies crural diaphragm and lower esophageal sphincter. </p> </div><div class="section"> <a class="named-anchor" id="d8570719e243"> <!-- named anchor --> </a> <h5 class="section-title" id="d8570719e244">Objectives</h5> <p id="d8570719e246">To assess the diagnostic accuracy of high-resolution manometry in detecting hiatal hernia compared to esophagogram and esophagogastroduodenoscopy, using as reference the surgical in vivo measurement. </p> </div><div class="section"> <a class="named-anchor" id="d8570719e248"> <!-- named anchor --> </a> <h5 class="section-title" id="d8570719e249">Methods</h5> <p id="d8570719e251">Patients were studied with esophagogram, esophagogastroduodenoscopy, high-resolution manometry and in vivo evaluation of the esophago-gastric junction. Esophago-gastric junction was classified as type I (no separation between crural diaphragm and lower esophageal sphincter); type II (≥1, ≤ 2 cm separation); type III (&gt;2 cm). During in vivo measurement, distance between the esophago-gastric junction and crural diaphragm proximal border was recorded. </p> </div><div class="section"> <a class="named-anchor" id="d8570719e253"> <!-- named anchor --> </a> <h5 class="section-title" id="d8570719e254">Results</h5> <p id="d8570719e256">Surgery identified 53 hiatal hernias in 100 patients. Forty-seven percent were classified as type I esophago-gastric junction, 35% type II and 18% type III. Referenced to in vivo evaluation, high-resolution manometry showed superior diagnostic sensitivity and specificity (94.3% and 91.5%, respectively) to esophagogram and esophagogastroduodenoscopy, with 92.6% predictive value of a positive test and 93.5% predictive value of a negative test. The kappa value for high-resolution manometry and in vivo evaluation was 0.85. High-resolution manometry showed optimal sensitivity and specificity in detecting types I, II and III esophago-gastric junction. </p> </div><div class="section"> <a class="named-anchor" id="d8570719e258"> <!-- named anchor --> </a> <h5 class="section-title" id="d8570719e259">Conclusions</h5> <p id="d8570719e261">High-resolution manometry enables an accurate diagnosis of hiatal hernia and a better classification than endoscopy and radiology, reaching optimal agreement with in vivo assessment. </p> </div>