Endoscopic Pressure Study Integrated System: Promising tool for evaluating the esophagogastric junction, but why not use it in the stomach as well?

We extend our sincere congratulations to Dr. Nishikawa and his team for their pioneering work on the Endoscopic Pressure Study Integrated System (EPSIS) for the diagnosis of achalasia and gastroesophageal reflux disease.1 This innovative approach holds great promise for advancing our understanding and diagnostic capabilities in esophageal motility disorders. Although the authors focused on the esophagogastric junction, we believe EPSIS has broader applications. It could be highly beneficial for studying functional dyspepsia and gastroparesis. The EPSIS device measures gastric pressure, making it a promising tool for assessing gastric body compliance during routine endoscopy. Gastric compliance disorders are a significant pathophysiological aspect of functional dyspepsia. Studies have shown reduced gastric compliance in functional dyspepsia, with barostats indicating a rapid increase in gastric pressure with lower balloon volumes. However, measuring this with a gastric barostat is challenging due to the device's limited availability and poor patient tolerance.2 Interestingly, there is a continuum between functional dyspepsia and gastroparesis, with overlapping profiles in 40% of cases.3 Although gastric peroral endoscopic myotomy (G-POEM) effectively treats gastroparesis, about 45% of patients face long-term failure, with unclear underlying causes. Our recent research indicates that gastric distensibility is significantly reduced in nonresponders to G-POEM, as evidenced by gastric volumetry.4 Additionally, gastric emptying scintigraphy meal repartition analysis shows poor utilization of the gastric body and fundus as meal storage areas in nonresponders to G-POEM, which may be related to poor relaxation of the gastric body and fundus.5 We believe EPSIS, as described in this study,1 could be useful in confirming these indicators in the pretherapeutic assessment of gastroparetic patients. This could help to determine if impaired gastric accommodation predicts G-POEM failure. We look forward to further developments in this field and how EPSIS can be integrated into broader clinical practice. Authors declare no conflict of interest for this article.