Comparative evaluation of single versus double leg raise maneuver in high‐resolution esophageal manometry

Background The straight leg raise (SLR) maneuver, often performed during esophageal manometry, requires patients to lift their leg(s) to augment intraabdominal pressure (IAP). Diverse techniques have been applied for SLR. This study aimed to evaluate and compare the effects of SLR between single and double leg raises. Methods During esophageal manometry, patients were asked to raise one leg, followed by elevating both legs. The efficacy of SLR for (1) detecting hiatal hernia, (2) increasing IAP, and (3) predicting gastroesophageal reflux disease (GERD) with intraesophageal pressure (IEP) was assessed. The value of change in impedance to indicate reflux during SLR in predicting esophageal acid exposure was investigated. Key Results The leg raise procedures were performed in 86 patients undergoing high‐resolution esophageal manometry. Both the single and double leg raises exhibited a higher hiatal hernia detection rate compared to the landmark (p = 0.008 and 0.005, respectively). Double leg raise was more effective in raising IAP by >50% compared to single leg raise (100% vs. 65.1%, p 6% with double leg raise (1.5 kΩ vs. 2.5 kΩ, p = 0.04). Conclusions & Inferences Our study demonstrates the efficacy of both single and double leg raise maneuvers during HREMI in increasing hiatal hernia detection and possible value in predicting GERD. The double leg raise resulted in a higher rate of effective increase in IAP, potentially enabling more patients to undergo effective SLR during HREMI. The straight leg raise (SLR) maneuver has been used as a method to assess esophagogastric junction (EGJ) competency during esophageal manometry. Several techniques involving the use of single or both legs have been used for SLR. Both the single and double leg raises were effective in detecting higher hiatal hernia in this study. Double leg raise was more effective in raising intraabdominal pressure by >50% compared to single leg raise. Encouraging patients to perform a double leg raise might facilitate more effective SLRs during HREMI.