title: Endoscopically assisted water perfusion esophageal manometry with minimal sedation: technique, indications, and implication on the clinical management.
abstract: OBJECTIVE
  To demonstrate feasibility and clinical utility of endoscopically assisted manometry (EAM).
  
  
  BACKGROUND
  Esophageal manometry performed without sedation is the standard for assessment of esophageal motility. However, some patients cannot tolerate the procedure with intranasal intubation. We have accumulated experience performing EAM with minimal sedation on patients who cannot tolerate standard esophageal manometry.
  
  
  METHODS
  We report our single center experience of EAM in adult patients. Patient records were analyzed retrospectively. PROCEDURE PROTOCOL: Upper endoscopy is performed with minimal sedation to place a guide wire, over which a water perfusion manometry catheter is introduced and standard manometry protocol performed.
  
  
  RESULTS
  From 2007 to 2009, 51 patients underwent EAM, 41 (80.4%) for failed transnasal esophageal manometry and 10 (19.6%) for Zencker diverticulum, achalasia, or neurologic disease. Five patients could not tolerate the procedure despite sedation. No early or late complications were recorded and 100% of the completed procedures were diagnostic: 15 (32.6%) patients had a normal study, 13 (28.3%) were diagnosed with achalasia, 12 (26.1%) patients had low lower esophageal sphincter pressure, 10 (21.7%) patients showed ineffective esophageal motility, 3 (6.5%) patients had hypertensive lower esophageal sphincter, and 1 (2.2%) patient had nutcracker esophagus. Completed procedures resulted in treatment for achalasia (33.3%), medication changes (33.3%), completion of preoperative assessment for antireflux surgery (27.7%), or no impact clinical management (11.1%). EAM had a direct clinical impact on 89% of patients.
  
  
  CONCLUSIONS
  EAM is a safe, reliable, and feasible technique providing objective diagnostic information that directly impacted clinical management in many problematic patients where the standard procedure failed.
authors: Massachusetts General Hospital, Gastroenterology, Boston, MA, USA.
authors: Rita
authors: R
authors: Brun
authors: Kyle
authors: K
authors: Staller
authors: Sofia
authors: S
authors: Viner
authors: Braden
authors: B
authors: Kuo
references: Gastrointest Endosc. 1975 Feb;21(3):126-8
references: 1112472
references: Am J Gastroenterol. 1987 Jun;82(6):523-5
references: 3578232
references: Am J Gastroenterol. 1993 Jun;88(6):860-3
references: 8503381
references: Anesth Analg. 2001 Jul;93(1):226-9
references: 11429371
references: Am J Gastroenterol. 1995 Nov;90(11):1985-8
references: 7485006
references: Neurogastroenterol Motil. 2000 Dec;12(6):567-72
references: 11123712
references: Can Vet J. 2005 Nov;46(11):995-1001
references: 16363326
references: Gut. 1979 Jan;20(1):64-7
references: 367884
references: BMC Neurosci. 2007 Aug 02;8:62
references: 17678546
references: Anesth Analg. 2006 Mar;102(3):876-81
references: 16492844
references: J Pediatr Gastroenterol Nutr. 1992 Jul;15(1):85-8
references: 1403454
references: Acta Anaesthesiol Scand. 2008 May;52(5):708-15
references: 18419726
references: Am J Gastroenterol. 1980 Feb;73(2):127-30
references: 7395839
references: Gut. 2001 Jul;49(1):145-51
references: 11413123
references: Dig Dis Sci. 1991 Aug;36(8):1046-9
references: 1864196
references: Dig Dis Sci. 1987 Jun;32(6):583-92
references: 3568945