The following is a summary of “Intra- and Inter-observer Agreement of High Resolution Antroduodenal Manometry in Pediatric Patients Among Single Center Experts” published in the December 2022 issue of Pediatric Gastroenterology and Nutrition by Valitutti et al.

It has been shown in adult patients that antroduodenal manometry’s (ADM) diagnostic yield can be improved with the help of high-resolution technology. However, there is no research contrasting conventional line plot (CLP), and pressure topographic plot (PTP) displays for ADM recordings, nor is there research contrasting the 2 types of high-resolution display. Researchers postulated that high-resolution ADM, in comparison to low-resolution recordings, is a more accurate diagnostic tool due to greater inter- and intra-observer agreement. Three seasoned pediatric neurogastroenterologists blindly reviewed 24 ADM investigations. Every 1 of the investigations was conducted with a 20-channel catheter in a low-compliance water perfused system. Data were presented in CLP, high-resolution, low-resolution, and PTP over many sessions separated by at least 6 weeks.

They used a combination of pre-and post-meal manometric patterns as well as previously established diagnostics to determine how well the test performed. Calculations of both inter- and intra-observer concordances were performed. According to the results of the high-resolution CLP analysis, there was a high level of agreement between the 3 observers with regard to the diagnosis (Krippendorff’s alpha = 0.832, with an average pairwise percentage agreement of 88.9%). In contrast, Krippendorff’s alpha was only 0.600 for high-resolution CLP and 0.390 for low-resolution CLP, indicating low agreement for diagnoses. Krippendorff’s alpha was between 0.891 and 1 for CLP and 0.19393 and 0.34621 for PTP when assessing intra-observer agreement.

High-resolution ADM recordings performed better in the investigation in terms of diagnostic accuracy than low-resolution recordings. Although PTP has been proven to be effective in a variety of studies involving motility, it has yet to be shown to be trustworthy when evaluating foregut motor patterns. There is no doubt that more complex and cutting-edge software is required to properly analyze PTP presentations.