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PubMed1988

Sphincter of Oddi manometry: comparison of microtransducer and perfusion methods.

There are two approaches to endoscopic sphincter of Oddi manometry, the microtransducer method and the perfusion method. Data reported by us and others are reviewed, with the aim of comparing the two techniques. Biliary pressure, pancreatic duct pressure, and sphincter of Oddi phasic wave activity can be measured by both of these methods. Easy handling and the capability of recording the mode of phasic wave propagation with a multilumen catheter are present advantages of perfusion manometry over the microtransducer method. Because there is no need for perfusion of fluid, the equipment needed for microtransducer manometry is simpler than that needed for the perfusion method, and the microtransducer technique may be more suitable for prolonged recording. An inter-study comparison of manometric data is easier with microtransducer manometry, but must await the collection of more data. Manometric differences between various diseases are still inconsistent, whereas there is no question of the effect of sphincterotomy on pressure values, with the exception of pancreatic duct and sphincter pressures. The possibilities of diagnosing sphincter of Oddi dysfunction, and of predicting the response to sphincterotomy have been received with enthusiasm. However, whether the findings obtained by endoscopic manometry over relatively short periods of time can be considered representative of overall sphincter function is now being questioned since the presence of physiologic cyclic changes in sphincter of Oddi phasic activity in phase with the migrating motor complex of the duodenum was demonstrated. Hormonal or pharmacological stimulation of sphincter activity may help us overcome this problem.

Ampulla of Vater↗

PubMed1997

[Perforation of the esophagus after esophageal manometry].

HISTORY AND FINDINGS: A 75-year-old man was admitted for oesophageal manometry because of dysphagia for the past 2 years and retrosternal burning sensation unrelated to exercise. His general condition was appropriate for his age. INVESTIGATIONS: An oesophagogram showed corkscrew-like deformation of a diffuse oesophageal spasm. The first, but incomplete, manometry recorded clearly propulsive contractions with markedly raised and prolonged pressure, as in "nutcracker oesophagus". The lower oesophageal sphincter could not be demonstrated initially. Subsequent pH measurements provided no evidence for increased gastrooesophageal reflux. TREATMENT AND FURTHER COURSE: After the first manometry conservative treatment was initiated with molsidomine, nifedipine and nitrospray sublingual, but the dysphagia was not significantly improved. A second manometry was performed before a planned surgical exploration. Placing of the catheter was again difficult and mild resistance experienced. Endoscopy revealed only minimal, presumably superficial, mucosal lesions. 2 days later bilateral pleural effusions together with mediastinitis occurred. Conservative treatment was continued until finally a distal oesophageal perforation was demonstrated. At surgery the perforation was seen and a oesophagectomy with gastric pull-through and intrathoracic anastomosis performed. However, the patient died of septic multi-organ failure. CONCLUSIONS: Oesophageal manometry is a safe but invasive method with few complications for measuring oesophageal motility. Although this has not previously been reported, oesophageal perforation with mediastinitis may end fatally, if the particular circumstances are unfavourable. In addition to special anatomical features, type and state of the manometric catheter may present a risk factor.

Aged↗

PubMed2005

Identification of hiatal hernia by esophageal manometry: is it reliable?

Hiatal hernias are frequently diagnosed during upper endoscopy or barium radiography. They can also be identified based on the typical 'double high pressure zone' or 'double hump' during stationary manometric pull-through. This paper aims to compare manometric and endoscopic identification of hiatal hernias. We retrospectively reviewed records of patients who had an esophageal manometry performed in our laboratory between July 2002 and July 2003. We identified 153 patients (104 females, mean age 56 years) who had both an esophageal manometry and upper endoscopy. The manometric studies were reviewed looking for the characteristic double high-pressure zone characteristic of hiatal hernia. The endoscopic reports were reviewed for the independent identification of an hiatal hernia. Information on race, gender, presence of hiatal hernias, esophagitis, and symptoms during esophagogastroduodenoscopy (EGD) exams was recorded from the reports of patients who had both EGD and manometric studies at our institution. Of the 153 patients with both endoscopy and manometry, 11 (7%) had an hiatal hernia identified by manometry compared to 51 (33%) by endoscopy. Ten (91%) of the manometrically identified hiatal hernias were also seen on endoscopy. Compared to endoscopy (gold standard), esophageal manometry had a sensitivity of 20% and a specificity of 99% for detecting hiatal hernias. Manometric identification of an hiatal hernia is an infrequent finding with low sensitivity but high specificity compared to endoscopy.

Adolescent↗

PubMed1984

Early changes in oesophageal function in progressive systemic sclerosis: a comparison of manometry and radiology.

The characteristics of oesophageal dysfunction were studied with manometry and cine radiography in a recumbent position in 21 patients with typical progressive systemic sclerosis (PSS). Manometry was also performed in a matched control group. Only one patient had a completely normal manometry. Mean resting pressure in both the upper and lower oesophageal sphincters were significantly decreased in PSS. Twelve patients had no detectable peristalsis in the lower oesophagus. In the upper oesophagus, the mean pressure amplitude of the peristalitic wave was found to be lower than normal in all patients with detectable peristalsis. In some patients, the only feature of oesophageal dysfunction observed was an increased speed of the peristaltic wave in the middle and lower oesophagus. This is interpreted as an impaired coordination of the propulsive peristalsis. Neuromuscular dysfunction of the oesophagus in its full length was thus clearly demonstrated. At cine radiography, three patients were judged as normal, and 13 patients had severe impairment of the peristaltic function in the distal two-thirds of oesophagus. Oesophageal scoring based on manometry correlated well to scoring based on radiography. Cine radiography of the recumbent patient gives adequate information for clinical purposes. Detection of early changes in the amplitude and speed of the propagation wave requires manometry.

Adult↗

PubMed2006

Safety and tolerability of transoral Bravo capsule placement after transnasal manometry using a validated conversion factor.

OBJECTIVES: To prospectively calculate and validate a conversion factor in healthy volunteers that allows accurate nonsedated, transoral (TO) Bravo capsule placement after transnasal (TN) manometry, and to evaluate the ease and safety of nonendoscopic Bravo placement compared with endoscopic placement. METHODS: Part 1. Twenty-five healthy volunteers underwent sequential TN and TO esophageal manometry to measure the distance to the lower esophageal sphincter (LES). A TN to TO conversion factor was calculated from these measurements. Part 2. Twenty volunteers underwent TN manometry followed by unsedated TO Bravo capsule placement using the conversion factor calculated in part 1. TN endoscopy then measured the location of the Bravo capsule in relationship to the squamocolumnar junction (SCJ). Part 3. During an 18-month period, 370 consecutive patients referred for a Bravo procedure underwent nonendoscopic, unsedated TO placement (308 patients) or standard endoscopically assisted placement (62 patients). RESULTS: Part 1. All 25 volunteers completed TN and TO manometry; a conversion factor of 4 cm was calculated. Part 2. Using the calculated conversion factor of 4 cm, a Bravo capsule was deployed TO 5 cm above the proximal border of the LES. The mean +/- standard deviation (SD) TN endoscopic distance to the capsule was 6.0 cm (+/-0.3 cm) above the SCJ. Part 3. A total of 333 patients completed the entire study (90%). Analysis of 48-h pH measurements did not reveal any significant differences between the two groups. CONCLUSIONS: A reliable and valid conversion factor of 4 cm following TN manometry permits accurate TO placement of the Bravo capsule without endoscopy. TO, unsedated Bravo placement is safe, well tolerated, and may minimize costs and potential risks associated with endoscopy.

Adolescent↗

PubMed2002

A review of oesophageal manometry testing in a district general hospital.

Although several modalities are available to investigate oesophageal motility disorders, manometry is the gold standard. The procedure is increasingly available in district general hospitals but the clinical utility of this investigation in this setting remains unclear. The aim in this study was to evaluate the use and outcome of oesophageal manometry in a district general hospital. Data on 100 consecutive oesophageal manometry procedures were analysed, taking into account the referral pattern, indications, and results. The indications were gastro-oesophageal reflux disease (preoperative assessment before fundoplication) (58), dysphagia (28), chest pain (12), and epigastric pain (2). Diagnoses were made using predefined standard criteria and were as follows: normal (41), non-specific motility disorder (NSMD) (38), achalasia (15), diffuse oesophageal spasm (4), and scleroderma (2). Of the 58 patients who had undergone manometry as a preoperative assessment of oesophageal motility, 27 (47%) were abnormal. Twenty five (43%) had NSMD and two (3%) had achalasia. Forty eight of these preoperative cases were combined with 24 hour pH recording, which confirmed acid reflux in 35 (73%). The experience reported here reflects the published evidence that the use of manometry is changing. It is now more commonly used for assessment before antireflux surgery and for dysphagia, and the use in the assessment of chest pain is declining. The findings confirm the importance of eliminating achalasia before inappropriate antireflux surgery.

Adolescent↗

PubMed2006

[Effectiveness of anorectal manometry using the balloon method to identify the inhibitory recto-anal reflex for diagnosis of Hirschsprung's disease].

OBJECTIVE: To evaluate results of anorectal manometry performed with equipment made in Brazil for the screening of Hirschsprung's disease in children with chronic constipation. METHODS: Results of 372 anorectal manometries performed consecutively in children with chronic constipation were evaluated. The equipment (Proctosystem Viotti) has two channels for pressure registration by the balloon method and is connected to a computer using specific software. Absence of the inhibitory recto-anal reflex was considered suggestive of Hirschsprung's disease and diagnosis was confirmed by traditional diagnostic methods. RESULTS: Absence of the inhibitory recto-anal reflex was found in 14 (3.8%) of the 372 anorectal manometry examinations. Diagnosis of Hirschsprung disease was confirmed in 9 out of 14 patients by characterization of aganglionosis upon rectal biopsy. In the other 5 patients, rectal biopsy was not performed in view of a satisfactory evolution with the clinical treatment for constipation. In 4 out of the 5 patients the inhibitory recto-anal reflex was demonstrated with a second anorectal manometry examination. CONCLUSIONS: The equipment used for anorectal manometry presented a satisfactory performance. Diagnosis of Hirschsprung disease was discarded in 86.5% of the patients with chronic constipation because the inhibitory recto-anal reflex was detected. Manometric evaluation also made possible the identification of a small group of patients in which more than half had Hirschsprung's disease.

Adolescent↗

PubMed1991

[Follow-up study of patients with achalasia treated by long myotomy + partial fundopexy + posterior fixation based on intraoperative manometry].

Long myotomy (6-8 cm) + partial fundopexy + posterior fixation with intraoperative manometry of the esophagus was performed in 23 cases of esophageal achalasia. These cases ranged from 24-72 years of age (average 42), 11 were males and 12 females. There were 19 primary cases and 4 postoperative cases of recurrence, and the period of their clinical courses ranged from 2 months to 23 years. Concerning the operative procedure, in 22 cases the approach was via an upper midline incision and 1 case the approach was via left thoraco-abdominal incision. Intraoperative manometry was performed to help in judging the extent of each manipulation. With the operative manipulation, the LESP is reduced to 13.0 +/- 6.0 mmHg (39% of the average preoperative value) and HPZ is elongated to 60.9 +/- 14.1 mm (155% of the average preoperative value). Moreover, post-operative manometry data resembled intra-operative data. The effectiveness of the procedure is judged on the basis of the chief complaints, esophagography, endoscopic examination, esophageal manometry and 24-hr pH monitoring. Patients are followed up at 2 weeks, 3 months and 1 year from the operation. Results showed 22 excellent cases (96.65%), 1 fair case (4.34%). These are better results than those of other reports that showed 50-60% excellent results and 30% good results (remaining slight passage disturbance). The reason for this difference is that we obtain sufficient LESP decompression effect (myotomy + submucosal layer ablation) based on intraoperative manometry. In the only case that we judged as fair (a reoperated case after Heller's operation) showed severe EGR totalling 213 min. on 24-hr pH monitoring of the esophagus in the postoperative period and was erosion also seen in the lower esophagus endoscopically. In this case, the LESP was 6.0 mmHg and its HPZ is 27.0 mm, showing a higher HPZ than the non-reflux group. Among the non-reflux group, LESP was as low as 6.0 mmHg, and this case had a remarkable long HPZ of 57.0 mm. In conclusion, even though the LESP is low, it is possible to prevent reflux if the HPZ is sufficiently long.

Adult↗

PubMed1991

Ambulatory 24-hour esophageal manometry in the evaluation of esophageal motor disorders and noncardiac chest pain.

Standard manometry is currently considered the gold standard for the classification of esophageal motor disorders. We compared the new technique of ambulatory 24-hour esophageal motility monitoring to standard manometry in 108 patients thought to have a primary esophageal motor disorder, assessed the esophageal motor pattern associated with spontaneous noncardiac chest pain, and studied the effect of long esophageal myotomy on circadian esophageal motor function. Standard manometry was found to frequently overestimate and underestimate the severity of esophageal motor abnormalities as compared to 24-hour monitoring. Ambulatory manometry showed a direct correlation of abnormal esophageal motor activity with episodes of noncardiac chest pain in 13 of 26 patients who experienced the symptom during the monitoring period. The abnormal motor activity immediately preceding the pain episodes in these patients was characterized by an increased frequency of simultaneous, double and triple-peaked, high amplitude, and long duration contractions (p less than 0.01). Long esophageal myotomy markedly reduced or eliminated the ability of the esophagus to produce these abnormal contractions (p less than 0.01). These data suggest that ambulatory esophageal motility monitoring allows more precise classification of esophageal motor disorders than standard manometry and identifies abnormal esophageal motor activity associated with noncardiac chest pain that can be abated by long esophageal myotomy.

Adult↗

PubMed1990

The usefulness of small-bowel manometry in the diagnosis of gastrointestinal motility disorders.

Motility disorders of the gastrointestinal (GI) tract have traditionally been diagnosed by excluding mechanical small-bowel obstruction. In order to diagnose GI motility disorders in a positive fashion, small-bowel manometry was performed on 15 patients who were referred to the authors with intestinal motility disorders. Intestinal manometry was performed after first positioning a 200-cm multilumen tube into the small intestine. Ports located at 10-cm intervals were perfused with sterile water and connected to pressure transducers to record intraluminal pressures with a multichannel chart recorder. This low compliance water perfusion manometry system allowed examination of both fasting and postprandial motility. Intestinal manometry was able to assist in the diagnosis of two patients that had true mechanical small-bowel obstruction. One patient had a stenosis of the gastrojejunostomy and three patients had a functional gastric outlet obstruction secondary to a motility disorder in the Roux limb. One patient had a functional obstruction from a reversed jejunal loop and eight patients were identified as having intestinal pseudo-obstruction. We found intestinal manometry was a helpful adjunct in the diagnosis of GI motility disorders.

Adult↗

PubMed1984

[Japan Study Group of Manometry of Digestive Tract in Childhood].

The Japan Study Group of Manometry of the Digestive Tract in Childhood was organized in 1975. The 14th meeting was held in February 1984. During the meeting, the technique of anorectal manometry was established and the criteria of positive recto-anal reflex was defined. The mechanism of recto-anal reflex has been studied, but the details of it remain obscure. The relationship between postoperative fecal continence and the findings of anorectal manometry of patients with anorectal disorders are currently being investigated. It is in dispute whether the recto-anal reflex is present or absent in patients with pseudo-Hirschsprung's disease. Study of esophageal manometry in children was added to the work of the group in 1978, and gastroesophageal reflux has been studied using manometry and/or pH measurement.

Child↗

PubMed1994

Simultaneous videoradiography and computerized pharyngeal manometry--videomanometry.

To obtain more information about muscle function in patients with dysphagia, simultaneous barium swallow and computerized pharyngeal manometry with solid-state pressure transducers was employed for the evaluation of the pharynx and the pharyngoesophageal segment (PES) in 30 consecutive patients. The manometry catheter was positioned under fluoroscopic control, providing localized measurements of the intraluminal pressures in the pharynx. Sixteen patients had a normal barium swallow. In 5 (31%) of these the manometry disclosed PES dysfunction, i.e. increased resting pressures between swallows in 3 patients (mean 120 +/- 13 mm Hg), and increased contraction pressures during peristalsis in 2 (mean 297 +/- 21 mm Hg). Barium swallow and manometry are complementary: the former reflecting transport through the pharynx and penetration to the airways, the latter the intraluminal pressures created by the pharyngeal wall. The combination of barium swallow and manometry gives information about pressure in relation to bolus transport, which may elucidate pharyngeal dysfunction.

Adult↗

PubMed1996

Comparative evaluation of cine-esophagogram with esophageal manometry in assessing esophageal motility in progressive systemic sclerosis.

BACKGROUND: Esophageal manometry is considered the gold standard in the diagnosis of esophageal motility disorders. Cine-esophagogram using barium is also a good investigation to screen patients for motor disorders of the esophagus. Comparison between these two investigations has not often been reported in patients with progressive systemic sclerosis (PSS). AIM: To determine relative merits of cine-esophagogram and esophageal manometry in detecting esophageal motor dysfunction in PSS patients. METHODS: Thirty-five patients with PSS irrespective of esophageal symptoms underwent esophageal manometry and cine-esophagogram, results and their were compared. RESULTS: Sensitivity and specificity of cine-esophagogram as compared to manometry were 96.1% (95% CI 88.7%-100%) and 55.5% (95% CI 23%-87.9%) respectively. Its positive predictive value was 86%. CONCLUSION: While esophageal manometry can identify esophageal motor disorder in PSS, cine-esophagogram can be resorted to in doubtful situations, for confirmation of diagnosis.

Adolescent↗

PubMed1996

[Reflux esophagitis: manometry and Ph measurement].

Manometry and pH-metry are essential in the examination of functional disturbances of the esophagus. Proven indications for manometry are dysphagia of unknown origin and noncardiac chest pain; in reflux esophagitis manometry is used for measuring pressure of the lower esophageal sphincter and detecting motility disorders of the esophageal body, pH-metry is used as long-term pH-metry to quantify gastroesophageal reflux during day and night; furthermore long-term pH-metry is important in the classification of atypical esophagitis. Recording gastroesophageal reflux and esophageal motility may influence planning of therapy and predict prognosis. Before antireflux surgery manometry and pH-metry are useful in judging the clearance mechanisms of the esophagus. Used critically, manometry and pH-metry can be very helpful as cost-effective diagnostic tools in the long-term therapy of reflux esophagitis.

Esophageal Motility Disorders↗

PubMed1998

[The use of anorectal manometry and dynamic proctography in patients for diagnosis of solitary rectal ulcer syndrome].

BACKGROUND: Solitary rectal ulcer syndrome is caused by rectal prolapse and/or anismus. The diagnosis by physical examination, or using endoscopy or radiology alone is difficult. AIM: To evaluate the diagnostic utility of videoproctography and anorectal manometry in solitary rectal ulcer syndrome. PATIENTS AND METHODS: We studied six patients (5 women/1 man; 21-66 years) with rectal lesions suggestive of solitary rectal ulcer. By videoproctography, we measured the changes in the anorectal angle and the shape of the rectal wall during voiding. By manometry, we measured the resting pressure of the anal canal, and the pressure during maximal voluntary contraction and during straining. RESULTS: Proctography showed a rectal prolapse in 5 patients (non-exteriorized in 4). Both manometry and proctography demonstrated the normal relaxation of puborectalis and external sphincter during straining in 4 patients, manometry found sphincteric weakness in two of these patients. Both manometry and proctography evidenced anismus in a patient with rectal prolapse. CONCLUSION: The high prevalence of rectal prolapse in our patients allows us to recommend proctography in patients with morphological lesions suggestive of solitary rectal ulcer. The manometric examination identifies patients at risk of developing incontinence. Both techniques contribute to ascertain the presence of anismus and are indispensable in the selection of the adequate treatment for patients with solitary rectal ulcer.

Adult↗

PubMed2001

Does anorectal manometry predict clinical outcome after laparoscopic ACE procedures in children with spina bifida?

PURPOSE: The laparoscopic antegrade continence enema (LACE) procedure is used for the treatment of faecal incontinence in children with spina bifida. The purpose of this study was to relate the outcome of the LACE procedure to anorectal function, as determined by anorectal manometry. METHOD: Eleven children with spina bifida who had the LACE procedure underwent anorectal manometry (ARM) to document their anorectal function, and its relationship to the level of continence obtained following surgery. RESULTS: There was a consistently high level of functional continence achieved following surgery despite wide variability in the parameters of anorectal manometry. There was no demonstrable correlation between the outcome of the LACE procedure and anorectal function as assessed by manometry. CONCLUSION: Anorectal function as determined by manometry failed to predict outcome after the laparoscopic ACE procedure in children with spina bifida.

Journal Article↗

PubMedDate not supplied

How safe is endoscopic sphincter of Oddi manometry?

The safety of endoscopic manometry of the sphincter of Oddi was evaluated in a prospective survey of 158 consecutive procedures in 126 patients with either unexplained pain after cholecystectomy or idiopathic recurrent pancreatitis. The only complication was that of pancreatitis which was defined as the development of abdominal pain in association with a plasma amylase above the reference range. This occurred in 13 patients (8%) and was more frequent (P = 0.001) when the indication for the procedure was idiopathic recurrent pancreatitis (29%) than unexplained pain (6%). Pancreatitis was also more frequent (P = 0.02) in patients with abnormal manometry (14%) than in those with normal manometry (3%) and occurred at highest frequency (50%) in a subgroup of patients with idiopathic recurrent pancreatitis and sphincter stenosis (high sphincter basal pressure). All episodes of pancreatitis were mild with a median increase in hospital stay of 2 days; no patients died. The risk of pancreatitis after endoscopic manometry is relatively low but increases in patients with abnormal sphincter manometry, particularly those with idiopathic recurrent pancreatitis.

Abdominal Pain↗

PubMedDate not supplied

[Role of anorectal manometry in the differential diagnosis of chronic constipation in children]

OBJECTIVES: 1. To evaluate the role of anorectal manometry in recognizing patients with histological abnormalities of the myenteric plexus as the cause of chronic constipation. 2. To correlate clinical features with the etiology of the constipation.METHODS: The etiology of the constipation was identified retrospectively from the medical records of 57 patients submitted to anorectal manometry. The test was performed in the Pediatric Gastroenterology Laboratory of the University Hospital of the State University of Campinas Medical School. The procedure was performed using a single-balloon system in which a water-perfused pressure transducer was interfaced with a polygraph and displayed on a computer screen. Manometry was performed in patients who, after 6 to 23 months of intense medical treatment using osmotic laxatives and dietary fibres (20 g/d), continued to develop fecal impaction and/or needed evacuatory enema. Regularization of bowel movements during at least 24 months follow-up or the visualization of abnormalities in myenteric plexus in rectal biopsy were used as reference points for the definitive diagnosis.RESULTS: Rectoanal reflex was present in 44 of the 57 patients (77%). Thirteen patients with a negative reflex underwent rectal biopsy which showed abnormalities of the ganglion cells in 10. Subsequent manometry performed on those three patients revealed a normal rectoanal reflex. Sensitivity, specificity, positive and negative predictive values of the manometric test were 1.0, 0.94, 0.77 and 1.0, respectively.CONCLUSIONS: Anorectal manometry is a diagnostic technique with very small possibility of error in differential diagnosis between constipation of a chronic functional nature and that which is secondary to ganglion cell abnormalities.

Journal Article↗