Topical anesthesia was provided with Cetacaine (benzocaine 14%, butamben 2%, and tetracaine hydrochloride 2%) spray to the throat and 5 mL of viscous lidocaine 2% solution to the nares. Subjects arrived at the endoscopy suite after fasting for a minimum of 6 hours. All MAC- and EGD-assisted HRiM studies were performed within one week of prior failed attempts of unsedated HRiM tests. We evaluated patients who had failed prior attempts at manometry in the office setting for this study. We report our single-center experience on endoscopy- and monitored anesthesia care- (MAC-) assisted high-resolution esophageal impedance manometry in adult patients to demonstrate the feasibility and effectiveness of this technique. Successful completion of the manometric study and diagnosis in this cohort resulted in treatment for achalasia (33.3%), change in medication (33.3%), and completion of preoperative assessment (27.7%). More recently, failure to perform transnasal manometry was circumvented by using an endoscopic-assisted over-the-wire technique, which utilized a water-perfusion motility catheter. However, according to the widely accepted Chicago classification, this technique lacks the metrics required for a diagnosis of a major motility disorder.
Another group reported accurate diagnoses of achalasia and esophageal scleroderma by directly visualizing swallows during videoendoscopy. However, these reports were limited by reduced peristaltic wave amplitudes due to the use of dry swallows. Previous reports trialed using through-the-scope manometric assessment revealed a good correlation between LES pressures obtained by standard manometry. No standardized alternative techniques exist.
#Publisher for mac 2018 series#
Twelve percent of the above-mentioned series of imperfect studies were due to inability to complete the minimum number of swallows for reasons including intolerance of the procedure, which include inability to intubate the nares or failure to traverse the LES. In prior studies, 21% of high-resolution manometry studies were technically imperfect and 29% of those were imperfect due to inability to traverse the lower esophageal sphincter (LES). However, some patients fail this approach due to a variety of reasons including poor tolerance or anatomic variants precluding intranasal intubation, coiling in the pharynx or esophagus, or hypersensitive gag reflex. The procedure is typically performed without sedation in the outpatient setting. Identification of specific esophageal motility disorders, especially subtypes of achalasia, is important, since this often guides therapeutic options. High-resolution impedance manometry (HRiM) with topography plotting incorporates impedance and manometry sensors, providing information on esophageal peristaltic patterns and pressures. IntroductionĮsophageal manometry has become the gold-standard test to diagnose esophageal motility disorders and is also useful in the evaluation of gastroesophageal reflux disease (GERD), noncardiac chest pain, or systemic conditions that may lead to esophageal dysmotility. The majority of these patients were treated successfully with targeted interventions, including per oral endoscopic myotomy, gastrostomy, botox injection, medical therapy, and dietary modifications. 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. We successfully completed HRiM studies in 14 consecutive patients. We then awakened the patients and asked them to perform 10 saline swallows. 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. Patients who had failed prior HRiM attempts received propofol under MAC. 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.
However, a substantial number of patients fail this approach.
HRiM is typically performed without sedation in the office setting. 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.
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