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2. 1O Safety, pharmacokinetics, efficacy, and biomarker results of SRK-181 (a latent TGFβ1 inhibitor) from a phase I trial (DRAGON trial)

Author

Yap, T.A., primary, Gainor, J., additional, McKean, M., additional, Bockorny, B., additional, Barve, M., additional, Sweis, R., additional, Vaishampayan, U.N., additional, Tarhini, A., additional, Kilari, D., additional, Chand, A., additional, Abdul-Karim, R., additional, Park, D., additional, Babu, S., additional, Ju, Y., additional, Dewall, S., additional, Liu, L., additional, Kennedy, A.M., additional, Marantz, J., additional, and Gan, L., additional

Published
2023
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3. 157P Phase I expansion of IMC-C103C, a MAGE-A4×CD3 ImmTAC bispecific protein, in ovarian carcinoma

Author

Sweis, R., primary, Garralda, E., additional, Saavedra Santa Gadea, O., additional, Moore, K.N., additional, Davar, D., additional, Hamid, O., additional, Segal, N.H., additional, Evans, T.R.J., additional, Dar, M., additional, Yuan, Y., additional, Collins, L., additional, Kirk, P.B., additional, Karakuzu, O., additional, Lopez, J.S., additional, and Melero, I., additional

Published
2022
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4. List of Contributors

Author

Abbatemarco, J.A., primary, Adams, R.J., additional, Adkins, D.L., additional, Akamatsu, Y., additional, Akyol, O., additional, Alexandrov, A.V., additional, Alim, I., additional, Alkhachroum, A.M., additional, Amin-Hanjani, S., additional, Andjelkovic, A.V., additional, Anrather, J., additional, Applegate, R., additional, Arai, K., additional, Ayata, C., additional, Aziz-Sultan, M.A., additional, Ballesteros, I., additional, Bar, B., additional, Barone, F.C., additional, Barrow, D.L., additional, Başkaya, M.K., additional, Bateman, K., additional, Bazan, N.G., additional, Beecher, J.S., additional, Beer-Furlan, A., additional, Belayev, L., additional, Bhattacharya, P., additional, Bhole, R., additional, Biller, J., additional, Biousse, V., additional, Borlongan, C.V., additional, Bouts, M.J.R.J., additional, Brey, R.L., additional, Bronstein, R., additional, Bryer, A., additional, Bulsara, K.R., additional, Can, A., additional, Canhão, P., additional, Caplan, L.R., additional, Carmichael, S.T., additional, Carrau, R., additional, Castaldo, J., additional, Catanese, L., additional, Chabriat, H., additional, Chaturvedi, S., additional, Chaudhary, N., additional, Chen, Jieli, additional, Chen, S., additional, Chen, Jun, additional, Choi, D.W., additional, Choi, B., additional, Chopp, M., additional, Chung, D.Y., additional, Chung, C.-P., additional, Cipolla, M.J., additional, Colbourne, F., additional, Colburn, Q., additional, Cord, B.J., additional, Coull, B.M., additional, Cuartero, M.I., additional, Cummings, J.L., additional, Dafer, R.M., additional, Dalkara, T., additional, Daou, B., additional, Dave, K.R., additional, Davis, T.P., additional, De Georgia, M., additional, De Silva, T.M., additional, Dharap, A., additional, Di Tullio, M.R., additional, Dietrich, W.D., additional, Dijkhuizen, R.M., additional, Dobkin, B.H., additional, Du, R., additional, Ducruet, A.F., additional, Duncan, K.R., additional, Edvinsson, L., additional, Edwards, M.J., additional, Egemen, E., additional, El-Hunjul, M., additional, Emanuele, M., additional, Emanuele, N., additional, Erdman, M.K., additional, Ergul, A., additional, Fagan, S.C., additional, Faraci, F.M., additional, Federau, C., additional, Ferro, J.M., additional, Fisher, M., additional, Flemming, K.D., additional, Foerch, C., additional, Freitas, R.S., additional, Friedlander, R.M., additional, Gaberel, T., additional, Gakuba, C., additional, Giffard, R.G., additional, Goldberg, M.P., additional, González, R.G., additional, Gopinath, S., additional, Gorelick, P.B., additional, Goshgarian, C., additional, Greenberg, D.A., additional, Griessenauer, C.J., additional, Groshans, K.A., additional, Gupta, R., additional, Hachem, R.A., additional, Hage, Z.A., additional, Hall, E.D., additional, Hamel, E., additional, Hao, Q., additional, Haqqani, A.S., additional, Hariman, R., additional, Hasan, D., additional, Haussen, D.C., additional, He, L., additional, Heiferman, D.M., additional, Herndon, J.M., additional, Ho, W.M., additional, Hoffmann, S., additional, Howard, B.M., additional, Hu, B.R., additional, Huber, J.D., additional, Huisa, B., additional, Hurn, P.D., additional, Iliff, J.J., additional, Jabbour, P., additional, Jamshidi, A.O., additional, Jankowitz, B., additional, Jickling, G.C., additional, Johansen, M., additional, Jovin, T.G., additional, Karuppagounder, S.S., additional, Kasper, E.M., additional, Keep, R.F., additional, Kim, H.-H., additional, Kim, D.E., additional, Kim, J.S., additional, Kim, J.Y., additional, Klahr, A.C., additional, Koch, M.J., additional, Kole, M., additional, Koleilat, S.M., additional, Kozan, A., additional, Kuroda, S., additional, Lamy, C., additional, Lanzino, G., additional, Larsen, A.G., additional, Laviv, Y., additional, Lawton, M.T., additional, Leary, M.C., additional, Leira, E.C., additional, Li, L., additional, Li, Q., additional, Liebeskind, D.S., additional, Lin, L., additional, Lioutas, V.A., additional, Lippert, T., additional, Liu, R., additional, Liu, J., additional, Liu, C.L., additional, Lizasoain, I., additional, Lo, E.H., additional, Loftus, C.M., additional, Logsdon, A.F., additional, Lucke-Wold, B.P., additional, Madhavan, S., additional, Madhugiri, V., additional, Malhotra, K., additional, Manning, W.J., additional, Marcell, S.J., additional, Mas, J.-L., additional, Masamoto, K., additional, Matute, C., additional, McCullough, L.D., additional, McDowell, M.M., additional, Mehdiratta, M., additional, Mehta, D., additional, Meisel, A., additional, Messegee, J., additional, Miller, B., additional, Mirza, S., additional, Modak, J.M., additional, Moro, M.A., additional, Nagel, M.A., additional, Namura, S., additional, Nedergaard, M., additional, Newell, D.W., additional, Newman, N.J., additional, Ng, K.L., additional, Nguyen, D., additional, Nguyen, H., additional, Nielsen, G., additional, Nishijima, Y., additional, Nishimura, N., additional, Nogueira, R.G., additional, Ogilvy, C.S., additional, Orbach, D.B., additional, Ostendorf, A.P., additional, Otto, B., additional, Ozpinar, A., additional, Panczykowski, D.M., additional, Patel, A.B., additional, Perez, Y., additional, Perez-Pinzon, M.A., additional, Potey, C., additional, Pradillo, J.M., additional, Prevedello, D.M., additional, Rajamani, K., additional, Rangel-Castilla, L., additional, Rao, N.M., additional, Ratan, R.R., additional, Raval, A.P., additional, Reddy, G.D., additional, Reis, C., additional, Roach, E.S., additional, Ronaldson, P.T., additional, Rosen, C.L., additional, Rosenberg, G.A., additional, Rutledge, W.C., additional, Sabzwari, R., additional, Salzano, G., additional, Santucci, P.A., additional, Saver, J.L., additional, Schallert, T., additional, Schermerhorn, M.L., additional, Schneck, M.J., additional, See, A.P., additional, Shakir, H.J., additional, Sharp, F.R., additional, Shuja, F., additional, Siddiqui, A.H., additional, Silva, M.A., additional, Singhal, A.B., additional, Sivakumar, K., additional, Slade, D.H., additional, Smith, E.R., additional, Sohrabji, F., additional, Solaroglu, I., additional, Sriraman, S.K., additional, Stamova, B., additional, Stanimirovic, D.B., additional, Stapleton, C.J., additional, Stary, C.M., additional, Steinberg, G.K., additional, Stephen, C., additional, Stetler, R.A., additional, Stone, J., additional, Sumbria, R., additional, Sweis, R., additional, Tahir, R., additional, Tarawneh, R., additional, Tarsia, J., additional, Tehrani, R., additional, Teo, M.K., additional, Testai, F.D., additional, Thrane, A.S., additional, Tobin, M.K., additional, Tome, M.E., additional, Topcuoglu, M.A., additional, Topel, C.H., additional, Torchilin, V., additional, Traystman, R.J., additional, Tsirka, S.E., additional, Turan, Y., additional, Tymianski, M., additional, van Leyen, K., additional, Varade, P., additional, Veluz, J.S., additional, Vemuganti, R., additional, Venkat, P., additional, Vexler, Z.S., additional, Vial, C.M., additional, Vinters, H.V., additional, Vosko, M.R., additional, Waeber, C., additional, Walcott, B.P., additional, Wang, J., additional, Wang, X., additional, Wang, Y.T., additional, Wei, Z.Z., additional, Wei, L., additional, Welch, B.G., additional, Winn, H.R., additional, Wintermark, M., additional, Wityk, R.J., additional, Wu, O., additional, Wu, K.C., additional, Xi, G., additional, Yacoub, H.A., additional, Yakhkind, A., additional, Yamamoto, Y., additional, Yang, S.-H., additional, Yenari, M., additional, Yigitkanli, K., additional, Yonas, H., additional, Yu, Z., additional, Zettervall, S.L., additional, Zhang, J., additional, Zhang, W., additional, and Zhao, H., additional

Published
2017
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7. Inter-observer agreement for diagnostic classification of esophageal motility disorders defined in high-resolution manometry

Author

Fox, M. R., Pandolfino, J. E., Sweis, R., Sauter, M., Abreu Y Abreu, A. T., Anggiansah, A., Bogte, A., Bredenoord, A. J., Dengler, W., Elvevi, A., Fruehauf, H., Gellersen, S., Ghosh, S., Gyawali, C. P., Heinrich, H., Hemmink, M., Jafari, J., Kaufman, E., Kessing, K., Kwiatek, M., Lubomyr, B., Banasiuk, M., Mion, F., Pérez-de-la-Serna, J., Remes-Troche, J. M., Rohof, W., Roman, S., Ruiz-de-León, A., Tutuian, R., Uscinowicz, M., Valdovinos, M. A., Vardar, R., Velosa, M., Waśko-Czopnik, D., Weijenborg, P., Wilshire, C., Wright, J., Zerbib, F., and Menne, D.

Published
2015
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12. The Clinical Relevance of Manometric Esophagogastric Junction Outflow Obstruction Can Be Determined Using Rapid Drink Challenge and Solid Swallows

Author

Sanagapalli, S, McGuire, J, Leong, RW, Patel, K, Raeburn, A, Abdul-Razakq, H, Plumb, A, Banks, M, Haidry, R, Lovat, L, Sehgal, V, Graham, D, Sami, SS, Sweis, R, Sanagapalli, S, McGuire, J, Leong, RW, Patel, K, Raeburn, A, Abdul-Razakq, H, Plumb, A, Banks, M, Haidry, R, Lovat, L, Sehgal, V, Graham, D, Sami, SS, and Sweis, R

Abstract

INTRODUCTION: Esophagogastric junction outflow obstruction (EGJOO) defined on high-resolution esophageal manometry (HRM) poses a management dilemma given marked variability in clinical manifestations. We hypothesized that findings from provocative testing (rapid drink challenge and solid swallows) could determine the clinical relevance of EGJOO. METHODS: In a retrospective cohort study, we included consecutive subjects between May 2016 and January 2020 with EGJOO. Standard HRM with 5-mL water swallows was followed by provocative testing. Barium esophagography findings were obtained. Cases with structural obstruction were separated from functional EGJOO, with the latter categorized as symptom-positive or symptom-negative. Only symptom-positive subjects were considered for achalasia-type therapies. Sensitivity and specificity for clinically relevant EGJOO during 5-mL water swallows, provocative testing, and barium were calculated. RESULTS: Of the 121 EGJOO cases, 76% had dysphagia and 25% had holdup on barium. Ninety-seven cases (84%) were defined as functional EGJOO. Symptom-positive EGJOO subjects were more likely to demonstrate abnormal motility and pressurization patterns and to reproduce symptoms during provocative testing, but not with 5-mL water swallows. Twenty-nine (30%) functional EGJOO subjects underwent achalasia-type therapy, with symptomatic response in 26 (90%). Forty-eight (49%) functional EGJOO cases were managed conservatively, with symptom remission in 78%. Although specificity was similar, provocative testing demonstrated superior sensitivity in identifying treatment responders from spontaneously remitting EGJOO (85%) compared with both 5-mL water swallows (54%; P < 0.01) and barium esophagography (54%; P = 0.02). DISCUSSION: Provocative testing during HRM is highly accurate in identifying clinically relevant EGJOO that benefits from therapy and should be routinely performed as part of the manometric protocol.

Published
2021

13. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0(C)

Author

Yadlapati, R, Kahrilas, PJ, Fox, MR, Bredenoord, AJ, Prakash Gyawali, C, Roman, S, Babaei, A, Mittal, RK, Rommel, N, Savarino, E, Sifrim, D, Smout, A, Vaezi, MF, Zerbib, F, Akiyama, J, Bhatia, S, Bor, S, Carlson, DA, Chen, JW, Cisternas, D, Cock, C, Coss-Adame, E, de Bortoli, N, Defilippi, C, Fass, R, Ghoshal, UC, Gonlachanvit, S, Hani, A, Hebbard, GS, Wook Jung, K, Katz, P, Katzka, DA, Khan, A, Kohn, GP, Lazarescu, A, Lengliner, J, Mittal, SK, Omari, T, Park, MI, Penagini, R, Pohl, D, Richter, JE, Serra, J, Sweis, R, Tack, J, Tatum, RP, Tutuian, R, Vela, MF, Wong, RK, Wu, JC, Xiao, Y, Pandolfino, JE, Yadlapati, R, Kahrilas, PJ, Fox, MR, Bredenoord, AJ, Prakash Gyawali, C, Roman, S, Babaei, A, Mittal, RK, Rommel, N, Savarino, E, Sifrim, D, Smout, A, Vaezi, MF, Zerbib, F, Akiyama, J, Bhatia, S, Bor, S, Carlson, DA, Chen, JW, Cisternas, D, Cock, C, Coss-Adame, E, de Bortoli, N, Defilippi, C, Fass, R, Ghoshal, UC, Gonlachanvit, S, Hani, A, Hebbard, GS, Wook Jung, K, Katz, P, Katzka, DA, Khan, A, Kohn, GP, Lazarescu, A, Lengliner, J, Mittal, SK, Omari, T, Park, MI, Penagini, R, Pohl, D, Richter, JE, Serra, J, Sweis, R, Tack, J, Tatum, RP, Tutuian, R, Vela, MF, Wong, RK, Wu, JC, Xiao, Y, and Pandolfino, JE

Abstract

Chicago Classification v4.0 (CCv4.0) is the updated classification scheme for esophageal motility disorders using metrics from high-resolution manometry (HRM). Fifty-two diverse international experts separated into seven working subgroups utilized formal validated methodologies over two-years to develop CCv4.0. Key updates in CCv.4.0 consist of a more rigorous and expansive HRM protocol that incorporates supine and upright test positions as well as provocative testing, a refined definition of esophagogastric junction (EGJ) outflow obstruction (EGJOO), more stringent diagnostic criteria for ineffective esophageal motility and description of baseline EGJ metrics. Further, the CCv4.0 sought to define motility disorder diagnoses as conclusive and inconclusive based on associated symptoms, and findings on provocative testing as well as supportive testing with barium esophagram with tablet and/or functional lumen imaging probe. These changes attempt to minimize ambiguity in prior iterations of Chicago Classification and provide more standardized and rigorous criteria for patterns of disorders of peristalsis and obstruction at the EGJ.

Published
2021

23. 705MO Sitravatinib (sitra) in combination with nivolumab (nivo) demonstrates clinical activity in checkpoint inhibitor (CPI) naïve, platinum-experienced patients (pts) with advanced or metastatic urothelial carcinoma (UC)

Author

Msaouel, P., primary, Siefker-Radtke, A.O., additional, Sweis, R., additional, Mao, S., additional, Rosenberg, J.E., additional, Vaishampayan, U.N., additional, Kalebasty, A. Rezazadeh, additional, Pili, R., additional, Bupathi, M., additional, Nordquist, L.T., additional, Shaffer, D.R., additional, Davis, N., additional, Zhang, T., additional, Gandhi, S., additional, Christensen, J., additional, Shazer, R., additional, Yan, X., additional, Winter, M., additional, Der-Torossian, H., additional, and Iyer, G. Vasudeva, additional

Published
2020
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30. Endoscopic management of gastrointestinal motility disorders - Part 1: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Author

Weusten, B. L. A. M., Barret, M., Bredenoord, A. J., Familiari, Pietro, Gonzalez, J. -M., Van Hooft, J. E., Ishaq, S., Lorenzo-Zuniga, V., Louis, H., Van Meer, S., Neumann, H., Pohl, D., Prat, F., Von Renteln, D., Savarino, E., Sweis, R., Tack, J., Tutuian, R., Martinek, J., Familiari P. (ORCID:0000-0002-5181-2928), Weusten, B. L. A. M., Barret, M., Bredenoord, A. J., Familiari, Pietro, Gonzalez, J. -M., Van Hooft, J. E., Ishaq, S., Lorenzo-Zuniga, V., Louis, H., Van Meer, S., Neumann, H., Pohl, D., Prat, F., Von Renteln, D., Savarino, E., Sweis, R., Tack, J., Tutuian, R., Martinek, J., and Familiari P. (ORCID:0000-0002-5181-2928)

Abstract

Main Recommendations ESGE recommends the use of a graded pneumatic dilation protocol in achalasia, starting with a 30-mm dilation and followed by a 35-mm dilation at a planned interval of 2-4 weeks, with a subsequent 40-mm dilation when there is insufficient relief, over both a single balloon dilation procedure or the use of a larger balloon from the outset. Strong recommendation, high quality of evidence, level of agreement 100%. ESGE recommends being cautious in treating spastic motility disorders other than achalasia with peroral endoscopic myotomy (POEM). Strong recommendation, very low quality of evidence, level of agreement 87.5%. ESGE recommends against the routine use of botulinum toxin injections to treat patients with non-achalasia hypercontractile esophageal motility disorders (Jackhammer esophagus, distal esophageal spasm). However, if, in individual patients, endoscopic injection of botulinum toxin is chosen, ESGE recommends performing injections into four quadrants of the lower esophageal sphincter and in the lower third of the esophagus. Strong recommendation, low quality of evidence, level of agreement 78.6%. ESGE recommends that endoscopic pylorus-directed therapy should be considered only in patients with symptoms suggestive of gastroparesis in combination with objective proof of delayed gastric emptying using a validated test, and only when medical therapy has failed. Strong recommendation, very low quality of evidence, level of agreement 100%. ESGE recommends against the use of botulinum toxin injection in the treatment of unselected patients with gastroparesis. Strong recommendation, high quality of evidence, level of agreement 92.9%. ESGE recommends consideration of gastric peroral endoscopic myotomy (G-POEM) in carefully selected patients only, because it is an emerging procedure with limited data on effectiveness, safety, and durability. G-POEM should be performed in expert centers only, preferably in the context of a clinical trial. Strong r

Published
2020

31. Endoscopic management of gastrointestinal motility disorders - part 2: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Author

Weusten, B. L. A. M., Barret, M., Bredenoord, A. J., Familiari, Pietro, Gonzalez, J. -M., Van Hooft, J. E., Lorenzo-Zuniga, V., Louis, H., Martinek, J., Van Meer, S., Neumann, H., Pohl, D., Prat, F., Von Renteln, D., Savarino, E., Sweis, R., Tack, J., Tutuian, R., Ishaq, S., Familiari P. (ORCID:0000-0002-5181-2928), Weusten, B. L. A. M., Barret, M., Bredenoord, A. J., Familiari, Pietro, Gonzalez, J. -M., Van Hooft, J. E., Lorenzo-Zuniga, V., Louis, H., Martinek, J., Van Meer, S., Neumann, H., Pohl, D., Prat, F., Von Renteln, D., Savarino, E., Sweis, R., Tack, J., Tutuian, R., Ishaq, S., and Familiari P. (ORCID:0000-0002-5181-2928)

Abstract

ESGE suggests flexible endoscopic treatment over open surgical treatment as first-line therapy for patients with a symptomatic Zenker's diverticulum of any size.Weak recommendation, low quality of evidence, level of agreement 100 %.ESGE recommends that emerging treatments for Zenker's diverticulum, such as Zenker's peroral endoscopic myotomy (Z-POEM) and tunneling, be considered as experimental; these treatments should be offered in a research setting only.Strong recommendation, low quality of evidence, level of agreement 100 %.ESGE recommends against the widespread clinical use of transoral incisionless fundoplication (TIF) as an alternative to proton pump inhibitor (PPI) therapy or antireflux surgery in the treatment of gastroesophageal reflux disease (GERD), because of the lack of data on the long-term outcomes, the inferiority of TIF to fundoplication, and its modest efficacy in only highly selected patients. TIF may have a role for patients with mild GERD who are not willing to take PPIs or undergo antireflux surgery.Strong recommendation, moderate quality of evidence, level of agreement 92.8 %.ESGE recommends against the use of the Medigus ultrasonic surgical endostapler (MUSE) in clinical practice because of insufficient data showing its effectiveness and safety in patients with GERD. MUSE should be used in clinical trials only.Strong recommendation, low quality evidence, level of agreement 100 %.ESGE recommends against the use of antireflux mucosectomy (ARMS) in routine clinical practice in the treatment of GERD because of the lack of data and its potential complications.Strong recommendation, low quality evidence, level of agreement 100 %.ESGE recommends endoscopic cecostomy only after conservative management with medical therapies or retrograde lavage has failed.Strong recommendation, low quality evidence, level of agreement 93.3 %.ESGE recommends fixing the cecum to the abdominal wall at three points (using T-anchors, a double-needle suturing device, or

Published
2020

32. Correction to: Toward a comprehensive view of cancer immune responsiveness: A synopsis from the SITC workshop (Journal for ImmunoTherapy of Cancer (2020) 7 (131) DOI: 10.1186/s40425-019-0602-4)

Author

Bedognetti, D., Ceccarelli, M., Galluzzi, L., Lu, R., Palucka, K., Samayoa, J., Spranger, S., Warren, S., Wong, K. -K., Ziv, E., Chowell, D., Coussens, L. M., De Carvalho, D. D., Denardo, D. G., Galon, J., Kaufman, H. L., Kirchhoff, T., Lotze, M. T., Luke, J. J., Minn, A. J., Politi, K., Shultz, L. D., Simon, R., Thorsson, V., Weidhaas, J. B., Ascierto, M. L., Ascierto, P. A., Barnes, J. M., Barsan, V., Bommareddy, P. K., Bot, A., Church, S. E., Ciliberto, G., De Maria, A., Draganov, D., W. S., Ho, Mcgee, H. M., Monette, A., Murphy, J. F., Nistico, P., Park, W., Patel, M., Quigley, M., Radvanyi, L., Raftopoulos, H., Rudqvist, N. -P., Snyder, A., Sweis, R. F., Valpione, S., Zappasodi, R., Butterfield, L. H., Disis, M. L., Fox, B. A., Cesano, A., and Marincola, F. M.

Published
2019

44. PWE-076 Specialist Centre Patient Volume Does Not Impact on Endoscopic Outcomes for Treatment of Barrett’s Dysplasia. Results from The UK Registry

Author

Lipman, G, primary, Gupta, A, additional, Banks, M, additional, Sweis, R, additional, Dunn, JM, additional, Morris, D, additional, Smart, H, additional, Bhandari, P, additional, Willert, RP, additional, Fullarton, G, additional, Morris, AJ, additional, Di Pietro, M, additional, Mundre, P, additional, Gordon, C, additional, Penman, I, additional, Barr, H, additional, Patel, P, additional, Boger, P, additional, Kapoor, N, additional, Mahon, BS, additional, Hoare, J, additional, Narayanasamy, R, additional, O’Toole, D, additional, Ang, Y, additional, Veitch, A, additional, Nylander, D, additional, Dhar, A, additional, Ragunath, K, additional, Leahy, A, additional, Fullard, M, additional, Haidry, R, additional, and Lovat, LB, additional

Published
2016
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49. Inter-observer agreement for diagnostic classification of esophageal motility disorders defined in high-resolution manometry

Author

Fox, Mark, Pandolfino, J E, Sweis, R, Sauter, M, Abreu Y Abreu, A T, Anggiansah, A, Bogte, A, Bredenoord, A J, Dengler, W, Elvevi, A, Fruehauf, H, Gellersen, S, Ghosh, S, Gyawali, C P, Heinrich, H, Hemmink, M, Jafari, J, Kaufman, E, Kessing, K, Kwiatek, M, Lubomyr, B, Banasiuk, M, Mion, F, Pérez-de-la-Serna, J, Remes-Troche, J M, Rohof, W, Roman, S, Ruiz-de-León, A, Tutuian, R, Uscinowicz, M, Valdovinos, M A, Vardar, R, Velosa, M, Waśko-Czopnik, D, Weijenborg, P, Wilshire, C, Wright, J, Zerbib, F, Menne, D, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Gastroenterology and Hepatology, and University of Zurich

Subjects
Adult, Observer Variation, Consensus, Manometry, 610 Medicine & health, Deglutition, Esophageal Achalasia, 10219 Clinic for Gastroenterology and Hepatology, Esophagus, Image Interpretation, Computer-Assisted, Humans, 2715 Gastroenterology, Esophageal Motility Disorders, Peristalsis, Single-Blind Method, Prospective Studies
Abstract

High-resolution esophageal manometry (HRM) is a recent development used in the evaluation of esophageal function. Our aim was to assess the inter-observer agreement for diagnosis of esophageal motility disorders using this technology. Practitioners registered on the HRM Working Group website were invited to review and classify (i) 147 individual water swallows and (ii) 40 diagnostic studies comprising 10 swallows using a drop-down menu that followed the Chicago Classification system. Data were presented using a standardized format with pressure contours without a summary of HRM metrics. The sequence of swallows was fixed for each user but randomized between users to avoid sequence bias. Participants were blinded to other entries. (i) Individual swallows were assessed by 18 practitioners (13 institutions). Consensus agreement (≤2/18 dissenters) was present for most cases of normal peristalsis and achalasia but not for cases of peristaltic dysmotility. (ii) Diagnostic studies were assessed by 36 practitioners (28 institutions). Overall inter-observer agreement was 'moderate' (kappa 0.51) being 'substantial' (kappa > 0.7) for achalasia type I/II and no lower than 'fair-moderate' (kappa >0.34) for any diagnosis. Overall agreement was somewhat higher among those that had performed >400 studies (n = 9; kappa 0.55) and 'substantial' among experts involved in development of the Chicago Classification system (n = 4; kappa 0.66). This prospective, randomized, and blinded study reports an acceptable level of inter-observer agreement for HRM diagnoses across the full spectrum of esophageal motility disorders for a large group of clinicians working in a range of medical institutions. Suboptimal agreement for diagnosis of peristaltic motility disorders highlights contribution of objective HRM metrics.

Published
2014
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50. Variation in esophageal physiology testing in clinical practice: Results from an international survey.

Author

the International Working Group for GI Motility and Function, Sweis, R., Heinrich, H., and Fox, M.

Subjects
*ESOPHAGEAL motility, *ESOPHAGEAL achalasia, *DATA acquisition systems, *GASTROESOPHAGEAL reflux, *VENTRICULAR outflow obstruction
Abstract

Abstract: Background: Advances in clinical measurement of esophageal motility and function have improved the assessment of swallowing disorders and reflux symptoms. Variation in data acquisition, analysis, and reporting exists and impacts on diagnosis and management. Aims and Methods: This study examined variation in esophageal manometry methodology between institutions to establish the status in current practice. A structured survey was distributed through international NGM societies using an Internet‐based platform. Questions explored infrastructure, technology, analysis, and reporting. Key Results: Responses were received from 91 centers from 29 countries. Eighteen (20%) centers used “conventional” manometry, 75 (82%) high‐resolution manometry, and 53 (58%) HR impedance manometry. All centers documented motility for single water swallows. The Chicago Classification was applied by 65 (71.4%) centers. In contrast, analysis of EGJ morphology varied widely. Adjunctive testing was often applied: multiple rapid swallows (77%), rapid drink challenge (77%), single solid swallows (63%), and a standard test meal (18%). Of 86 (94.5%) units that offered pH impedance (pH‐Z) studies, approximately half (53.5%) performed tests on acid‐suppressant medication in patients with a high pretest probability (eg, erosive esophagitis). Most (75.6%) centers manually reviewed every reflux event. Others examined pH‐Z data only prior to symptoms. To assess symptom association with reflux events, 73.6% centers analyzed each symptom separately, whereas 29.7% centers pooled symptoms. Conclusions and Inferences: There is marked variation in the data acquisition, analysis, and reporting of esophageal manometry studies. Further efforts to improve quality and uniformity in testing and reporting are required. This survey provides information upon which best‐practice guidelines can be developed. [ABSTRACT FROM AUTHOR]

Published
2018
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