Esophageal Acclimation to Catheter Placement During High-Resolution Manometry: A Case Series: 344

Introduction: While many labs allow patients to acclimate to catheter placement prior to undergoing measurement, there is no agreement about the ideal timing of measurement. Our experience at a military tertiary care center suggests that a standardized period of acclimation should be employed to minimize pressure artifact and obtain the correct diagnosis. Six cases are presented where a 10 minute acclimation period resulted in 6 different diagnoses versus obtaining a measurement immediately following catheter placement.Table. DemographicsTable: Table. IRP4, DCI and Diagnosis Before and After AcclimationMethods: Topical anesthesia (Lidocaine) was given as a gargle and trans-nasally. A unidirectional MMS-catheter was positioned such that measurements of the UES, LES and gastric pressures could be obtained. Immediately following catheter placement, the patient underwent five 5 ml swallows. This was followed by a 10 minute acclimation period when the patient's history was obtained. Ten 5 ml swallows were then performed. Swallow vigor, integrity and IRP4 were obtained for each phase of swallows and appropriate Chicago Classification V3 diagnoses were applied. Results: The mean age of our patients (3 M, 3F, mean age: 41.5±9.4 yrs.) with varying symptoms (see chart). Mean IRP4 decreased in all patients (15.42 vs. 12.92 mmHg, mean %change -13.89%±0.5935, P=0.4) except for one patient with achalasia type II whose IRP increased during the 2nd measurement. DCI decreased markedly between the 1st and 2nd measurement (1888 vs. 757 mmHg, mean change=-1131±626 mm Hg, P=0.1056). Most significantly, the diagnosis changed in all six patients between the first and second measurement. Conclusion: (1) A significant change in esophageal motility findings occurs if patients are allowed to acclimate and relax prior to HRM testing. (2) Following a period of acclimation, esophageal body (DCI) and LESp decrease. (3) These motility changes may result in different esophageal motility diagnosis. (4) More stable HRM results occurs by waiting a 10 minutes prior to performing in the procedure. We hypothesize that fluid build-up, anxiety and esophageal spasm or relaxation triggered by catheter placement could contribute to false measurements, though more controlled research and larger trials are needed to confirm our suspicions.