Correlation between antroduodenal manometry and histopathology in paediatric intestinal pseudo-obstruction

Abstract

Background: Currently, the diagnosis of paediatric intestinal pseudo-obstruction (PIPO) is primarily based on clinical picture, which mimics small intestinal obstruction in the absence of luminal occlusion. Antroduodenal manometry (ADM) and histopathology have been applied to definitively diagnose PIPO and classify subtypes of disease (neuropathy, myopathy and neuro-myopathy). However, there are limited data regarding the reliability of current protocols for ADM analysis as well as how well this correlates with histopathological findings. Objective: To develop enhanced analysis of gastrointestinal contractile patterns on ADM, including a practical scoring system, and correlate these with histopathology from small intestinal full thickness biopsies in the same children with PIPO. Methods: We included all patients referred for PIPO investigation to the Gastroenterology Service at Great Ormond Street Hospital between April 2012-July 2019, and who had both ADM (completed study ≥20 hours) and histopathology results available to review. All ADM tracings were thoroughly analysed using both standard (original ADM) and novel (enhanced ADM) contractile parameters. Using the enhanced analysis, an ADM score based on key contractile elements across the entire study was generated. Both this score and the original ADM analysis were correlated with histopathological findings. Results: There were 15 PIPO and 11 non-PIPO patients included in this study. Of 15 patients, 14 (84.6%) were reported to have abnormal histopathologic features: 4 neuropathy, 2 neuro-myopathy, 1 myopathy; and 7 patients had changes of uncertain clinical significance. No significant agreement was found between the diagnostic labels from 'original ADM' analyses and histopathology (κ = 0.012; P = 0.91). However, enhanced ADM scores were different between subtypes of PIPO, especially between neuropathic and non-neuropathic groups (24 vs 13; P = 0.03); and showed better correlation with histopathology (Figure 1). Median ADM scores were significantly higher in PIPO, compared to non-PIPO patients (14 vs 8; P < 0.001). Conclusions: PIPO diagnostic labels derived from currently applied analyses of ADM tracings do not correlate with abnormalities seen on histopathology. Our scores derived from enhanced ADM analyses show better correlation with histopathology. We propose to further validate the enhanced ADM analysis and scoring for clinical use in patients with presumed PIPO.L6320784392020-07-29 <br />