Esophageal Manometry Periprocedural Care

Updated: Sep 09, 2016
  • Author: Philip O Katz, MD, FACP, FACG; Chief Editor: Kurt E Roberts, MD  more...
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Periprocedural Care

Patient Education and Consent

One of the key aspects of a successful esophageal manometry study is to thoroughly explain the procedure beforehand to patients so as to bring down their anxiety levels. The prospect of having a tube passed through the nose and into the stomach can generate apprehension that can interfere with the technical quality of the study. Patients need to be assured that although they may be uncomfortable, it is not a painful study and they will not choke.

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Preprocedural Planning

The patient should not have anything to eat or drink for at least 4 hours before the procedure (diabetic patients should take nothing orally after midnight the night before).

Regular medications can be taken with a small amount of water. Although some medications may alter esophageal motility (eg, antispasmodics, prokinetic agents, analgesics, opiates, or sedatives), if the patient is taking them on a daily basis for a chronic condition, it may make sense to perform the study while the patient is on these medications, so as to factor in their systemic effects in the test results and decide on possible further therapy. Because it is difficult to interpret abnormalities in the setting of these medications, repeat procedures off therapy may be required.

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Equipment

Equipment for esophageal manometry includes the following:

  • Manometry catheter - High-resolution manometry (HRM) is the current standard; solid-state systems are acceptable if no other equipment is available
  • Manometer software with computer monitor
  • Lidocaine spray
  • Water-based lubricant
  • Glass of water with straw
  • Syringe, 60 mL
  • Normal saline solution (if performing manometry with impedance)
  • High ionic gel-consistency solution (for patient to swallow for impedance measurements)
  • Tape such as Transpore 3M TM (to secure manometry catheter to patient's nose throughout the procedure)
  • Tissues (to offer to patient as needed throughout the procedure)

As a side note, it is recommended that all liquids and disposable items be kept on a movable cart away from computer and electronic equipment.

Equipment is shown in the image below.

Equipment used for performing esophageal manometry Equipment used for performing esophageal manometry with impedance: lidocaine spray, water-based lubricant, syringe, normal saline solution, gel-consistency solution with high ionic content, tape, tissues, glass with water, and straw.
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Patient Preparation

Anesthesia

Because the purpose of esophageal manometry is to record esophageal pressures for further understanding of esophageal motility and function, the procedure must be done in a patient who is fully awake and conscious. The areas through which the manometry catheter will be passed are anesthetized with a topical anesthetic, such as lidocaine spray for the pharynx and viscous lidocaine for the sinuses.

Positioning

With the patient sitting upright, the pharynx and the nostril are anesthetized. In the same position, the catheter is passed through the nose, down the throat, and through the esophagus into the stomach while the patient takes small sips (see Technique).

Afterward, the patient is asked to lay down; the motility testing itself of the lower esophageal sphincter (LES) and esophageal body function should always be performed in a supine patient. Although some esophageal motility laboratories continue to perform this study in the upright position, no set of upright normal values exists that could be comparable to established supine normal values.

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Monitoring & Follow-up

The patient can resume his or her regular diet after the procedure. Any sore throat or discomfort can be alleviated by over-the-counter lozenges. The patient can usually expect a few days to pass before being notified of the results; the study must be analyzed and interpreted by the technician, the gastroenterologist, or both.

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