Guidewire-assisted placement of water-perfused esophageal high-resolution manometry probe when gastric insertion fails: A single-center experience.
achalasia
esophagus
high-resolution manometry
motility disorder
Journal
Neurogastroenterology and motility
ISSN: 1365-2982
Titre abrégé: Neurogastroenterol Motil
Pays: England
ID NLM: 9432572
Informations de publication
Date de publication:
09 2022
09 2022
Historique:
revised:
17
03
2022
received:
01
11
2021
accepted:
22
03
2022
pubmed:
17
4
2022
medline:
31
8
2022
entrez:
16
4
2022
Statut:
ppublish
Résumé
Blind positioning of a high-resolution manometry (HRM) probe across the esophagogastric junction (EGJ) is not always possible. We report our experience using guidewire-assisted water-perfused HRM probe insertion when the EGJ could not be traversed. Retrospective study analyzing the failure rate of EGJ insertion during HRM, and reporting a series of guidewire-assisted procedures. Among 2727 HRM procedures, the failure rate for traversing the EGJ was 2.7% (73 patients). The technique of guidewire-assisted placement of the HRM probe was used in 25 patients; it was well-tolerated and successful in all patients. No motility disorder was found in 6 patients. In four patients with previously diagnosed achalasia, achalasia subtype changed to type III in one patient. While a suspected motility disorder at barium esophagram and/or initial imperfect HRM tracing was confirmed in 10 patients, a new motility disorder was diagnosed in five patients using guidewire-assisted placement of the HRM probe. In cases of inability to traverse the EGJ, insertion of a water-perfused HRM probe using an endoscopically-placed nasogastric guidewire allows successful EGJ and esophageal peristalsis assessment. Although motility disorders are often suspected using alternative diagnostic modalities, guidewire-assisted placement of HRM may be helpful for revealing them in patients where alternative diagnostic modalities are either unavailable or inconclusive.
Sections du résumé
BACKGROUND
Blind positioning of a high-resolution manometry (HRM) probe across the esophagogastric junction (EGJ) is not always possible. We report our experience using guidewire-assisted water-perfused HRM probe insertion when the EGJ could not be traversed.
METHODS
Retrospective study analyzing the failure rate of EGJ insertion during HRM, and reporting a series of guidewire-assisted procedures.
KEY RESULTS
Among 2727 HRM procedures, the failure rate for traversing the EGJ was 2.7% (73 patients). The technique of guidewire-assisted placement of the HRM probe was used in 25 patients; it was well-tolerated and successful in all patients. No motility disorder was found in 6 patients. In four patients with previously diagnosed achalasia, achalasia subtype changed to type III in one patient. While a suspected motility disorder at barium esophagram and/or initial imperfect HRM tracing was confirmed in 10 patients, a new motility disorder was diagnosed in five patients using guidewire-assisted placement of the HRM probe.
CONCLUSIONS AND INFERENCES
In cases of inability to traverse the EGJ, insertion of a water-perfused HRM probe using an endoscopically-placed nasogastric guidewire allows successful EGJ and esophageal peristalsis assessment. Although motility disorders are often suspected using alternative diagnostic modalities, guidewire-assisted placement of HRM may be helpful for revealing them in patients where alternative diagnostic modalities are either unavailable or inconclusive.
Substances chimiques
Water
059QF0KO0R
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14379Informations de copyright
© 2022 John Wiley & Sons Ltd.
Références
Tack J, Pauwels A, Roman S, et al. European Society for Neurogastroenterology and Motility (ESNM) recommendations for the use of high-resolution manometry of the esophagus. Neurogastroenterol Motil. 2021;33(5):e14043. doi:10.1111/nmo.14043
Yadlapati R, Kahrilas PJ, Fox MR, et al. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0©. Neurogastroenterol Motil. 2021;33(1):e14058. doi:10.1111/nmo.14058
Kahrilas PJ, Bredenoord AJ, Fox M, et al. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27(2):160-174. doi:10.1111/nmo.12477
Roman S, Kahrilas PJ, Boris L, Bidari K, Luger D, Pandolfino JE. High-resolution manometry studies are frequently imperfect but usually still interpretable. Clin Gastroenterol Hepatol. 2011;9(12):1050-1055. doi:10.1016/j.cgh.2011.08.007
Hengehold T, Rogers B, Gyawali CP. Imperfect high-resolution manometry studies: prevalence and predictive factors. NeurOgastroenterol Motil. 2021:e14273. doi:10.1111/nmo.14273. Epub ahead of print. PMID: 34636124.
Vicentine FP, Herbella FA, Silva LC, Patti MG. High resolution manometry findings in patients with esophageal epiphrenic diverticula. Am Surg. 2011;77(12):1661-1664.
Carlson DA, Gluskin AB, Mogni B, et al. Esophageal diverticula are associated with propagating peristalsis: a study utilizing high-resolution manometry. Neurogastroenterol Motil. 2016;28(3):392-398. doi:10.1111/nmo.12739
Freidin N, Eidelman S, Danieli Z, Bergman I. Insertion of dent sleeve catheter using a guidewire in achalasia. Gastrointest Endosc. 1992;38(6):699-700. doi:10.1016/s0016-5107(92)70568-9
Gurala D, Philipose J, Polavarapu AD, El Douaihy Y, Mulrooney SM. Roth net-assisted endoscopic-guided manometry catheter placement. Cureus. 2020;12(8):e10063. doi:10.7759/cureus.10063
Rohof WO, Salvador R, Annese V, et al. Outcomes of treatment for achalasia depend on manometric subtype. Gastroenterology. 2013;144(4):718-725. doi:10.1053/j.gastro.2012.12.027
Vaezi MF, Pandolfino JE, Yadlapati RH, Greer KB, Kavitt RT. ACG clinical guidelines: diagnosis and management of achalasia. Am J Gastroenterol. 2020;115(9):1393-1411. doi:10.14309/ajg.0000000000000731
Nabi Z, Chavan R, Asif S, et al. Per-oral endoscopic myotomy with division of septum (D-POEM) in epiphrenic esophageal diverticula: outcomes at a median follow-up of two years. Dysphagia. 2021. doi:10.1007/s00455-021-10339-8. Epub ahead of print.