INTRODUCTION The insertion of a high-resolution manometry (HRM) catheter into the stomach is essential for accurate manometric diagnoses; however, it is impossible in some cases due to the inability to traverse the esophagogastric junction (EGJ). Predictive factors for these patients have not been investigated in detail, necessitating time-consuming and burdensome procedures for investigators and patients. Therefore, the present study investigated the percentage of and risk factors for failed intubation at the EGJ. METHODS We initially reviewed the medical charts of consecutive HRM procedures performed at our hospital between September 2018 and January 2023. Patient characteristics and the findings of endoscopy and esophagography (where available) were compared between successful and failed procedures. A multivariate logistic regression analysis was conducted to identify predictive factors for the inability to traverse the EGJ. We then validated the predictive factors identified by reviewing consecutive procedures performed between February 2023 and August 2023. RESULTS Among the 781 procedures performed, 55 (7.0%) failed due to the inability to traverse the EGJ. Achalasia was the most common disorder in these procedures. An older age and dilated esophagus of >34 mm were independent predictive factors for the inability to traverse the EGJ in patients with treatment-naïve achalasia. In the validation study, 7 out of 68 procedures (10.3%) failed due to the inability to traverse the EGJ. A flowchart using the findings of endoscopy and an esophageal diameter of >34 mm predicted the inability to traverse the EGJ with a sensitivity of 71.4% and specificity of 86.9%. CONCLUSION Based on an esophageal diameter >34 mm and endoscopic findings, we predicted the inability to traverse the EGJ in more than 70% of patients. A multi-center prospective study is warranted in the future.

中文翻译：

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贲门失弛缓症患者的食管扩张是测压导管无法穿过食管胃交界处的预测因素。

简介 将高分辨率测压 (HRM) 导管插入胃中对于准确的测压诊断至关重要。然而，在某些情况下这是不可能的，因为无法穿过食管胃交界处（EGJ）。这些患者的预测因素尚未得到详细研究，因此研究人员和患者需要进行耗时且繁重的程序。因此，本研究调查了 EGJ 插管失败的百分比和危险因素。方法 我们最初回顾了 2018 年 9 月至 2023 年 1 月期间在我们医院进行的连续 HRM 手术的病历。比较成功和失败手术的患者特征以及内窥镜和食管造影（如果有）的结果。进行多变量逻辑回归分析以确定无法穿越 EGJ 的预测因素。然后，我们通过审查 2023 年 2 月至 2023 年 8 月期间执行的连续手术来验证所确定的预测因素。 结果 在执行的 781 例手术中，55 例 (7.0%) 由于无法穿越 EGJ 而失败。贲门失弛缓症是这些手术中最常见的疾病。对于初治贲门失弛缓症患者来说，年龄较大和食管扩张>34 mm是无法穿过食管胃结合部的独立预测因素。在验证研究中，68 例手术中有 7 例 (10.3%) 由于无法穿过 EGJ 而失败。使用内窥镜检查结果和食管直径 >34 mm 的流程图预测无法穿过 EGJ，敏感性为 71.4%，特异性为 86.9%。结论 根据食管直径 >34 mm 和内窥镜检查结果，我们预测超过 70% 的患者无法穿过 EGJ。未来有必要进行多中心前瞻性研究。