Simplifying the esophagogastric junction contractile integral calculation

BACKGROUND: The esophagogastric junction contractile integral (EGJ-CI) is a manometric parameter used to assess EGJ function. EGJ-CI must be manually calculated using a multi-step process. An earlier metric, the lower esophageal sphincter pressure integral (LESPI), is conceptually similar to EGJ-CI, but has a more straightforward calculation algorithm. AIMS: This study aimed at proposing a new, easier to calculate metric, the modified EGJ-CI (m-EGJ-CI) and to compare its fidelity to EGJ-CI. METHODS: After Institutional Review Board (IRB) approval, we conducted a cross-sectional study. High-resolution manometry studies performed between February 2018 and October 2024 at our center were retrieved. Patients with prior foregut procedures, distal esophageal spasm, hypercontractile esophagus, EGJ outflow disorders, hiatal hernias > 5 cm and lung transplant candidates/recipients were excluded. An experienced interpreter calculated the EGJ-CI and m-EGJ-CI for each study. Correlations were assessed using Spearman's rank coefficient. The complexity of each parameter was estimated based on the calculation time required. RESULTS: Studies from 84 patients (58 women [69%]; median age, 61 years [IQR 49.5-69.5]) were re-analyzed. A strong positive correlation between EGJ-CI and m-EGJ-CI was found (ρ = 0.839 [95%CI = 0.72-0.96], p < 0.05). The cumulative time for m-EGJ-CI calculations was significantly lower than that for EGJ-CI (15.7 vs. 60.3 min, p < 0.05). CONCLUSIONS: The EGJ-CI calculation as an indicator of EGJ competence may be overly complex and time-consuming. The m-EGJ-CI saves time without compromising fidelity to EGJ-CI and can potentially be automated in future software versions.