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The following is a summary of “Quality Indicator Development for the Approach to Ineffective Esophageal Motility: A Modified Delphi Study,” published in the November 2024 issue of Gastroenterology by Kamal et al.    

Ineffective esophageal motility (IEM) is recognized in up to 20% of patients undergoing esophageal high-resolution manometry (HRM), but its clinical significance and management remain unclear.  

Researchers conducted a prospective study to develop quality indicators for the management of IEM.  

They used the RAND/University of California, Los Angeles Appropriateness Methods (RAND/UCLA) and a modified-Delphi approach to develop quality indicator statements, 10 esophageal experts rated 12 proposed statements in 3 iterative rounds (importance, scientific acceptability, usability, and feasibility).  

The results showed that 10 experts rated 12 proposed quality indicators. In round 1, 7 indicators showed mixed agreement on most categories. Following rounds 2 and 3, 2 indicators reached comprehensive agreement, 4 showed partial agreement, and 1 had no agreement. Panelists agreed on determining IEM’s clinical relevance and managing gastroesophageal reflux disease (GERD) rather than focusing on the IEM pattern but disagreed on the use of promotility agents and mixed agreement on IEM’s role in anti-reflux surgery planning.  

They concluded that 2 quality indicators were identified, highlighting the challenges in managing IEM and the need for further research on the clinical significance.  

Source: journals.lww.com/jcge/abstract/2024/11000/quality_indicator_development_for_the_approach_to.7.aspx