Endoscopically Assisted Water Perfusion Esophageal Manometry With Minimal Sedation

Brun, Rita; Staller, Kyle; Viner, Sofia; Kuo, Braden

doi:10.1097/mcg.0b013e3182098bcd

Cited by 10 publications

(7 citation statements)

References 8 publications

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“…1 Additionally, previous studies have reported sedationassisted esophageal manometry, which may aid completion of manometry for patients who could not tolerate the test during awake placement of the manometry catheter. [2][3][4] Placing the catheter while the patient is under sedation can help mitigate some of the discomfort and help complete the exam. Additionally, some situations require endoscopic-guidance of the manometric catheter to achieve the necessary positioning across the esophagogastric junction, eg, esophageal tortuosity with large hiatal hernia or achalasia.…”

Section: Introductionmentioning

confidence: 99%

Performing High-resolution Impedance Manometry After Endoscopy With Conscious Sedation Has Negligible Effects on Esophageal Motility Results

Carlson

Donnan

et al. 2020

J Neurogastroenterol Motil

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Background/Aims High-resolution manometry (HRM) performed without sedation is the standard procedure. However, some patients cannot tolerate transnasal placement of the manometry catheter. We aim to assess the practice of performing manometry after endoscopy with conscious sedation by evaluating its impact on esophageal motility findings. Methods Twelve asymptomatic adult volunteers and 7 adult patients completed high-resolution impedance manometry (HRIM) approximately 1 hour after conscious sedation with midazolam and fentanyl (post-sedation) and again on a different day with no-sedation. The nosedation HRIM involved 2 series of swallows separated in time by 20 minutes (no-sedation-1 and no-sedation-2) for the volunteers; patients completed only 1 series of swallows for no-sedation HRM. Results A motility diagnosis of normal motility was observed in all 12 volunteers post-sedation. Two volunteers had a diagnosis of borderline ineffective esophageal motility, one during the no-sedation-1 period and the other during the no-sedation-2 period; all of the other no-sedation HRIM studies yielded a normal motility diagnosis. Six of seven patients had the same diagnosis in both no-sedation and post-sedation HRM, including 1 distal esophageal spasm, 3 achalasia (2 type II and 1 type III), and 2 esophagogastric junction outflow obstruction. Only one patient's HRM classification changed from ineffective esophageal motility at no-sedation to normal esophageal motility at post-sedation. Conclusions Performing HRIM after endoscopy with conscious sedation had minimal clinical impact on the motility diagnosis or motility parameters. Thus, this approach may be a viable alternative for patients who cannot tolerate unsedated catheter placement.

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Section: Introductionmentioning

confidence: 99%

Performing High-resolution Impedance Manometry After Endoscopy With Conscious Sedation Has Negligible Effects on Esophageal Motility Results

Carlson

Donnan

et al. 2020

J Neurogastroenterol Motil

View full text Add to dashboard Cite

show abstract

“…Currently, there is a scarcity of the data exploring effects of sedation on manometric esophageal parameters. We opine that sedation-assisted esophageal manometry is frequently practiced but seldom reported [8, 9]. Hence, to guide the management of such patients where sedation-assisted HRM is utilized, it is imperative to conduct more research exploring this group of patients.…”

Section: Introductionmentioning

confidence: 99%

Revisiting the Reliability of the Endoscopy and Sedation-Assisted High-Resolution Esophageal Motility Assessment

et al. 2019

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Background Esophageal high-resolution manometry (HRM) is performed for evaluation of dysphagia or the pre-operative evaluation before esophageal surgery. The esophageal manometry parameters, interpreted as per the Chicago classification (CC), are meant to be acquired in an awake state. At times, the patient intolerance or inability to traverse the manometry catheter across the esophagogastric junction (EGJ) renders incomplete esophageal motility evaluation; hence, sedation or endoscopy assistance is required. There have been concerns raised regarding the use of sedation and resultant alteration of the manometry parameters. The aims were to study the effects of intravenous sedation on esophageal motility parameters and analyze its impact on outcomes of patients with dysphagia who are intolerant to awake manometry procedure. Methods The study population comprised patients who had sedation or the endoscopy assistance for the HRM. The indication for HRM, necessity for the sedation, manometry findings, barium esophagogram results, procedural timings and patient outcomes were reviewed. The diagnostic impact of the 10% correction in integrated relaxation pressure (IRP) was also studied. Results There were 14 patients from 179 awake manometry procedures that required the sedation or the endoscopy assistance. The mean age was 60.7 years and there was equal gender distribution. Dysphagia (n = 9) remained the predominant indication for the HRM, followed by the pre-operative evaluation for the esophageal surgery (n = 5). In eight patients, awake manometry failed due to the coiling of the catheter above the EGJ and six patients were intolerant to awake catheter insertion technique. Six patients were diagnosed with achalasia and two with EGJ obstruction. The correction of the possible 10% inflation of the IRP did not alter the final diagnosis in majority except one patient with the EGJ obstruction. The findings of the barium esophagogram corroborated the manometry diagnosis. Conclusion Esophageal HRM should be done in awake state as much as possible. Sedation may be a feasible option as against aborting the further workup in patients who fail with current techniques involving awake catheter insertion. However, one needs to be mindful of sedation effects on manometry parameters and interpret results carefully.

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“…Conventionally, topical nasopharyngeal anesthesia is applied to improve the tolerance of these tests . However, there are currently no data to support this practice.…”

Section: Introductionmentioning

confidence: 99%

Is topical lidocaine beneficial before catheter insertion in esophageal manometry and ambulatory pH monitoring?

Wahba

Neshkova

Vuille‐Lessard

et al. 2019

Neurogastroenterology Motil

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Background Conventionally, topical anesthesia is applied to improve the tolerance of esophageal manometry (EM) and ambulatory pH monitoring (apH) but there is presently no evidence supporting this practice. We aimed to compare the tolerance of EM and apH with vs without topical lidocaine anesthesia. Methods A prospective study was conducted at our center between January 2017 and January 2019. All patients who underwent EM or apH and completed a systematically distributed standardized patient survey were included. From January 2017 to June 2018, all patients had a viscous lidocaine solution applied before EM and apH (“lidocaine” group). After June 2018, we ceased applying any topical anesthesia (“no lidocaine” group). Patient‐reported adverse effects and satisfaction scores were compared between these two patient groups. Key Results Two hundred forty‐nine patient surveys were included. “Lidocaine” (n = 124) and “no lidocaine” (n = 125) groups were similar in age (56.9 ± 14.0 vs 56.0 ± 13.7; P = .77) and gender distributions (65.9% vs 63.3% female; P = .68). Patients in the “lidocaine” group were less likely to report pain during catheter insertion (33.6% vs 50.8%; P = .007, OR: 0.49 [95% CI 0.29‐0.83]) and reported a lower overall pain score (2.82 ± 1.38 vs 3.20 ± 1.42 on 5; P = .04). There was a tendency toward increased global satisfaction with lidocaine application but that was not statistically significant (4.36 ± 1.05 vs 4.11 ± 1.13; P = .08). In subgroup analyses, female patients, younger patients, and patients who underwent EM were more likely to benefit from lidocaine application. Conclusions and Inferences Application of topical lidocaine before esophageal motility tests reduces pain during catheter insertion and overall pain.

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Endoscopically Assisted Water Perfusion Esophageal Manometry With Minimal Sedation

Cited by 10 publications

References 8 publications

Performing High-resolution Impedance Manometry After Endoscopy With Conscious Sedation Has Negligible Effects on Esophageal Motility Results

Performing High-resolution Impedance Manometry After Endoscopy With Conscious Sedation Has Negligible Effects on Esophageal Motility Results

Revisiting the Reliability of the Endoscopy and Sedation-Assisted High-Resolution Esophageal Motility Assessment

Is topical lidocaine beneficial before catheter insertion in esophageal manometry and ambulatory pH monitoring?

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