scholarly journals Endoscopy- and Monitored Anesthesia Care-Assisted High-Resolution Impedance Manometry Improves Clinical Management

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Kaci E. Christian ◽  
John D. Morris ◽  
Guofeng Xie
Keyword(s):  
High Resolution ◽  
Esophageal Motility ◽  
Anesthesia Care ◽  
Monitored Anesthesia Care ◽  
Ineffective Esophageal Motility ◽  
Targeted Interventions ◽  
Single Center Experience ◽  
Esophageal Spasm ◽  
Number Of Patients ◽  
Per Oral

Background. High-resolution impedance manometry (HRiM) is the test of choice to diagnose esophageal motility disorders and is particularly useful for identifying achalasia subtypes, which often guide therapy. HRiM is typically performed without sedation in the office setting. However, a substantial number of patients fail this approach. We report our single-center experience on endoscopy-assisted HRiM under monitored anesthesia care (MAC) in adults to demonstrate the feasibility and effectiveness of this approach. Methods. Patients who had failed prior HRiM attempts received propofol under MAC. Patients then underwent an upper endoscopy, followed immediately by passage of a Diversateck HRiM motility catheter through the nares and under direct visualization into the stomach, often using the tip of the endoscope to guide the catheter. We then awakened the patients and asked them to perform 10 saline swallows. Results. We successfully completed HRiM studies in 14 consecutive patients. Six patients had achalasia; two had esophagogastric junction outflow obstruction; two had absent contractility; one had distal esophageal spasm; one had ineffective esophageal motility; and one had a normal study. The majority of these patients were treated successfully with targeted interventions, including per oral endoscopic myotomy, gastrostomy, botox injection, medical therapy, and dietary modifications.

scholarly journals A pictorial presentation of 3.0 Chicago Classification for esophageal motility disorders

2016 ◽  
Vol 14 (3) ◽  
pp. 439-442 ◽  
Author(s):  
Fernando Augusto Herbella ◽  
Priscila Rodrigues Armijo ◽  
Marco Giuseppe Patti
Keyword(s):  
High Resolution ◽  
Esophageal Motility ◽  
Esophagogastric Junction ◽  
Esophageal Motility Disorders ◽  
Motility Disorders ◽  
High Resolution Manometry ◽  
Ineffective Esophageal Motility ◽  
Chicago Classification ◽  
Esophageal Spasm ◽  
Pictorial Presentation

ABSTRACT High resolution manometry changed several esophageal motility paradigms. The 3.0 Chicago Classification defined manometric criteria for named esophageal motility disorders. We present a pictorial atlas of motility disorders. Achalasia types, esophagogastric junction obstruction, absent contractility, distal esophageal spasm, hypercontractile esophagus (jackhammer), ineffective esophageal motility, and fragmented peristalsis are depicted with high-resolution manometry plots.

Changes in high-resolution manometric diagnosis over time: implications for clinical decision-making

2020 ◽  
Vol 33 (3) ◽  
Author(s):  
George Triadafilopoulos ◽  
Afrin Kamal ◽  
Thomas Zikos ◽  
Linda Nguyen ◽  
John O Clarke
Keyword(s):  
High Resolution ◽  
Esophageal Motility ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Primary Objective ◽  
Diffuse Esophageal Spasm ◽  
Ineffective Esophageal Motility ◽  
Esophageal Spasm ◽  
The Stability ◽  
Over Time

Summary Although High resolution esophageal manometry (HRM) is the gold standard to assess esophageal motility, little is known about the stability of the manometric diagnosis over time and its implications for management. To assess the stability and usefulness of repeat HRM in patients presenting with esophageal symptoms over time we performed this retrospective study of patients with esophageal symptoms. Medical records, questionnaires, and HRM tracing were independently reviewed using the Chicago classification. The primary objective was to assess the stability of the manometric diagnosis over time; secondary objective was its change (positive or negative). At least one repeat study was performed in 86 patients (36% women, ages 20–86, with mild to moderate symptoms), while 26 had a third procedure. Mean intervals between studies were 15 ± 1.6 months (for baseline v. first study) and 13 ± 0.8 months (for second to third study). Of the 27 patients initially with a normal study, 11 changed (five had esophago-gastric junction outflow obstruction [EGJOO], two diffuse esophageal spasm [DES], one jackhammer esophagus [JE], and three ineffective esophageal motility [IEM] [41% change]). Of the 24 patients with initial EGJOO, only nine retained it (65.2% change). Of nine patients with initial DES, four changed (44.4% change). Similarly, different diagnosis was seen in 7 of 24 initial IEM patients (22.7% change). Only one patient had achalasia initially and this remained stable. Additional changes were noted on a third HRM. Fluidity in the HRM diagnosis over time questions its validity at any timepoint and raises doubts about the need for intervention.

P173 HIGH-RESOLUTION MANOMETRIC FINDINGS AFTER MAGNETIC SPHINCTER AUGMENTATION

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Carlo Galdino Riva ◽  
Stefano Siboni ◽  
Veronica Lazzari ◽  
Marco Sozzi ◽  
Emanuele Asti ◽  
...  
Keyword(s):  
High Resolution ◽  
Esophageal Motility ◽  
Symptom Relief ◽  
Rank Test ◽  
Barium Swallow ◽  
Upper Gastrointestinal Endoscopy ◽  
Magnetic Sphincter Augmentation ◽  
Hrql Score ◽  
High Resolution Manometry ◽  
Ineffective Esophageal Motility

Abstract Aim The aim of this study was to evaluate esophageal motility before and after Magnetic Sphincter Augmentation (MSA) for medically refractory Gastro-Esophageal Reflux Disease (GERD). Background and Methods MSA (LINX® Reflux Management System) is intended for patients with chronic GERD with incomplete symptom relief from proton-pump inhibitors (PPI) and abnormal acid exposure. A prospectively collected database of patients who underwent MSA between 2007 and 2019 was queried. All patients who completed pre- and post-operative high-resolution manometry (HRM) were included in the study. Additional investigations included Health-Related Quality of Life (GERD-HRQL) questionnaire, Functional Outcome Swallowing Scale (FOSS), upper gastrointestinal endoscopy, barium swallow, and 24-96 hours pH-study. Data were analyzed using Wilcoxon signed rank test and McNemar test. Results Forty-five patients met the inclusion criteria. The median follow-up was 10 months (IQR 6). Compared to baseline, there was a statistically significant reduction in PPI use (p=0.000), rate of heartburn (p=0.000), regurgitation (p=0.008), and extra-esophageal symptoms (p=0.000). Only three (6.7%) patients required dietary changes. The GERD-HRQL score significantly improved (p=0.000). There was a significant increase in the Lower Esophageal Sphincter (LES) competency, including LES length (p=0.004) and Esophago-gastric Contractile Integral ((EGJ-CI) (p=0.000). A significant increase in integrated relaxation pressure (IRP) (p=0.000), mean Distal Contractile Integral (DCI) (p=0.008) and intrabolus pressure (p=0.000) was also found. Thirteen (28.9%) patients presented pre-operative Ineffective Esophageal Motility (IEM) and five of them resolved postoperatively. Two patients (4.4%) developed IEM after surgery: both had IRP and DCI values within normal limits, and one of them complained of dysphagia. However, the GERD-HRQL score recovered in both patients. Conclusion MSA was clinically effective in relieving both typical and atypical GERD symptoms. LES competency increased after MSA. EGJ outflow obstruction was uncommon and not associated with symptoms. Finally, ineffective esophageal motility may reverse to normal after MSA.

Tu1412 IMPACT OF INEFFECTIVE ESOPHAGEAL MOTILITY ON SECONDARY PERISTALSIS IN GERD: STUDIES WITH HIGH RESOLUTION MANOMETRY

2020 ◽  
Vol 158 (6) ◽  
pp. S-1095-S-1096
Author(s):  
Wei-Yi Lei ◽  
Jen-Hung Wang ◽  
Ming-Wun Wong ◽  
Chih-Hsun Yi ◽  
Tso-Tsai Liu ◽  
...  
Keyword(s):  
High Resolution ◽  
Esophageal Motility ◽  
High Resolution Manometry ◽  
Ineffective Esophageal Motility ◽  
Secondary Peristalsis

scholarly journals High-Resolution Manometry Correlates of Ineffective Esophageal Motility

2012 ◽  
Vol 107 (11) ◽  
pp. 1647-1654 ◽  
Author(s):  
Yinglian Xiao ◽  
Peter J Kahrilas ◽  
Mary J Kwasny ◽  
Sabine Roman ◽  
Zhiyue Lin ◽  
...  
Keyword(s):  
High Resolution ◽  
Esophageal Motility ◽  
High Resolution Manometry ◽  
Ineffective Esophageal Motility

scholarly journals The Effect of Diet Composition Change on High-Resolution Oesophageal Manometry Metrics in Non-Erosive Gastroesophageal Reflux Disease Patients

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 54-54
Author(s):  
Sergey Morozov ◽  
Vasily Isakov
Keyword(s):  
High Resolution ◽  
Esophageal Motility ◽  
Esophageal Manometry ◽  
Diet Composition ◽  
Control Group ◽  
Study Group ◽  
Ineffective Esophageal Motility ◽  
Dietary Fiber Intake ◽  
Significant Difference ◽  
Resting Pressure

Abstract Objectives To evaluate the influence of change of diet composition on esophageal manometry metrics. Methods The data of 43 NERD patients with low (<20 g/day) baseline dietary fiber intake served as a source data. These patients were examined with the use of standard food frequency questionnaire and high-resolution esophageal manometry. Thirty of them received psyllium 5.0 g TID 10 days in addition of their usual diet within registered clinical trial (NCT01882088). The other 13 were found in the database by diagnosis; their data were eligible in case of the presence of repeated high-resolution esophageal manometry examination and dietary assessments at the same time point and if no significant change in diet composition was revealed. The changes were assessed in accordance to Chicago classification 3.0. Non-parametric statistics (Wilcoxon matched pairs test, Mann-Whitney U-test) were used to assess the change in HRM metrics in these groups. Results In those who received psyllium, significant increase of minimal lower esophageal resting pressure at rest and after 10 water swallows was registered: 5.41 ± 10.1 vs 11.3 ± 9.4 mm Hg, P = 0.023 and 14.1 ± 8.0 vs 14.9 ± 6.4 mm Hg, P = 0.008, accordingly. No significant difference was found in the group with no change of diet composition by these parameters. At baseline, ineffective esophageal motility was found in 46.7% patients of the study group and 53.8% in the control group (P = 0.7). Esophageal motility became normal in 71.4% of those who had IEM initially in the study group after 10 days of treatment, and in 14.3% among the controls (P = 0.0135). This type of peristaltic abnormality was found not changed in 28.6% of the study group and in 85.7% among the control group, P = 0.014. New cases of ineffective esophageal motility revealed in 12.5% of the study group and 16.7% among the controls (P = 0.8) Conclusions Change of diet composition by additional quantity of psyllium may result in the improvement of esophageal motility. Funding Sources Federal Research Center of Nutrition and Biotechnology.

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