Goals 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 can not tolerate the procedure with intranasal intubation. We have accumulated experience performing EAM with minimal sedation on patients that can not tolerate standard esophageal manometry. Study 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 2007-2009, 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 LES pressure, 10 (21.7%) patients demonstrated Ineffective Esophageal Motility, 3 (6.5%) patients had hypertensive LES, and one (2.2%) patient had Nutcracker esophagus. Completed procedures resulted in treatment for achalasia (33.3%), medication changes (33.3%), completion of pre-operative 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.
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