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Low EXS, Wang YP, Ye YC, Liu PY, Sung KY, Lin HE, Lu CL. A Comparison between Chicago Classification Versions 3.0 and 4.0 and Their Impact on Manometric Diagnoses in Esophageal High-Resolution Manometry Cases. Diagnostics (Basel) 2024; 14:263. [PMID: 38337780 PMCID: PMC10854946 DOI: 10.3390/diagnostics14030263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/14/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
High-resolution manometry (HRM) facilitates the detailed evaluation of esophageal motility. In December 2020, Chicago classification (CC) version 4.0 introduced modifications to improve consistency and accuracy. We conducted this study to compare the differences in the interpretations of HRM examinations between CC 3.0 and 4.0. Consecutive HRM records at a Taiwan tertiary medical center, including wet swallows and MRS performed in both supine and sitting positions from October 2019 to May 2021, were retrospectively reviewed and analyzed using both CC versions 3.0 and 4.0. A total of 105 patients were enrolled, and 102 patients completed the exam, while three could not tolerate HRM sitting up. Refractory gastroesophageal reflux disease (GERD) symptoms (n = 65, 63.7%) and dysphagia (n = 37, 36.3%) were the main indications. A total of 18 patients (17.6%) were reclassified to new diagnoses using CC 4.0. Of the 11 patients initially diagnosed with absent contractility, 3 (27.3%) were reclassified as having Type 1 achalasia. Of the 18 patients initially diagnosed with IEM, 6 (33.3%) were reclassified as normal. The incidence of diagnosis changes was similar in both the dysphagia and refractory GERD symptoms groups (21.6% versus 15.3%, p = 0.43). The use of CC 4.0 led to changes in the diagnoses of esophageal motility disease, irrespective of examination indications. Early adoption improves the accuracy of diagnoses and affects patient management.
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Affiliation(s)
- En Xian Sarah Low
- Endoscopy Center for Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (E.X.S.L.); (Y.-C.Y.); (P.-Y.L.); (K.-Y.S.); (H.-E.L.)
- Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Department of Medicine, Ng Teng Fong General Hospital, National University Health System, Singapore 609606, Singapore
| | - Yen-Po Wang
- Endoscopy Center for Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (E.X.S.L.); (Y.-C.Y.); (P.-Y.L.); (K.-Y.S.); (H.-E.L.)
- Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Institute of Brain Science, National Yang-Ming University, Taipei 11221, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei 11221, Taiwan
| | - Yong-Cheng Ye
- Endoscopy Center for Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (E.X.S.L.); (Y.-C.Y.); (P.-Y.L.); (K.-Y.S.); (H.-E.L.)
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei 11221, Taiwan
| | - Pei-Yi Liu
- Endoscopy Center for Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (E.X.S.L.); (Y.-C.Y.); (P.-Y.L.); (K.-Y.S.); (H.-E.L.)
| | - Kuan-Yi Sung
- Endoscopy Center for Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (E.X.S.L.); (Y.-C.Y.); (P.-Y.L.); (K.-Y.S.); (H.-E.L.)
- Division of Gastroenterology, Department of Medicine, Fu Jen Catholic University Hospital, Taipei 24352, Taiwan
| | - Hung-En Lin
- Endoscopy Center for Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (E.X.S.L.); (Y.-C.Y.); (P.-Y.L.); (K.-Y.S.); (H.-E.L.)
- Division of Gastroenterology, Department of Medicine, Taipei City Hospital Chongxing Branch, Taipei 10321, Taiwan
| | - Ching-Liang Lu
- Endoscopy Center for Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (E.X.S.L.); (Y.-C.Y.); (P.-Y.L.); (K.-Y.S.); (H.-E.L.)
- Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Institute of Brain Science, National Yang-Ming University, Taipei 11221, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei 11221, Taiwan
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