Straight leg raise, a new complementary test in esophageal high-resolution manometry

This systematic review aimed to explore the diagnostic utility of the straight leg raise (SLR) maneuver as a complementary test with high-resolution manometry (HRM), particularly in gastroesophageal reflux disease (GERD).The methodology included a comprehensive literature review and analysis of retrieved papers based on eligibility criteria and the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines.Outcomes included protocols of SLR, an association of SLR test with the esophagogastric junction (EGJ) function, esophageal motility, and reflux severity, and other clinical applications of SLR, including Milan score (MS) and post-operative assessment.Of the 96 retrieved papers, 12 were eventually analyzed.The most common SLR protocol involved raising one or both legs to a hip flexion angle of approximately 45 with the knees extended for about 5 s, repeating at least twice.The SLR test was able to uncover a weakened anti-reflux barrier even when the EGJ morphology appeared intact.In addition, the SLR test was shown to be a useful motility surrogate for esophageal contraction reserve.A significant increase in intraesophageal pressure (IEP) or decrease in contractile segment impedance (CSI) after SLR was also shown to predict reflux severity.The MS, derived from three GERD-related manometric metrics and IEP from the SLR test, has been proven to be reliable in GERD stratification and post-operative assessment.Limitations of the SLR test included lack of standardized technique, lack of long-term outcome data, absence of normative values, and unclear roles of body mass index.In conclusion, SLR is a valid and reliable complementary test with HRM in the diagnosis and management of GERD.