Comprehensive "One-Stop Shop" Esophageal Motility Workup During Propofol Endoscopy: Safe, Feasible, and Convenient

Introduction: In evaluating dysphagia or refractory GERD, patients typically undergo several diagnostic studies including EGD, endoluminal functional lumen imaging probe (EndoFLIP), and high-resolution esophageal manometry (HREM). Endoscopy, EndoFLIP, and pH monitoring can be performed in one single procedure while under sedation. However, HREM is typically performed separately without sedation as it requires patient cooperation. Many patients have difficulty tolerating trans-nasal placement of the manometry catheter. At our center we developed a protocol in which EGD, EndoFLIP, and HREM is performed for a patient on the same day using propofol sedation. With this protocol, we first perform EGD with EndoFLIP while patients are under monitored anesthesia care or general anesthesia, using only propofol, without use of inhalation agents or paralytics. While asleep, a manometry catheter is placed under endoscopic guidance. Afterwards, the patients are brought to the recovery area where the HRM equipment resides. Once the patient is awake enough to follow commands, they undergo the standard manometry protocol. Methods: We performed a retrospective review of patients that had undergone EGD/EndoFLIP/HREM during single-session endoscopy. Data collected included detailed patient characteristics, indications for study, and diagnoses. Three main outcome measures were evaluated: Technical success was measured by uncomplicated manometry catheter placement and absence of equipment malfunction, Clinical success was defined by manometry tracing data sufficient for suitable interpretation by a motility specialist and Patient safety. Results: We identified 71 patients (mean age 60, 78% female) who underwent EGD, Endoflip, and HREM during single-session endoscopy under propofol sedation. Procedure indication was dysphagia in 46 (65%) and GERD/heartburn in 24 (34%) of cases. Technical success of HREM was achieved in 70/71 (99%) of patients; equipment malfunction precluded successful HREM in 1 patient. Clinical success was achieved in 67/70 (96%) of cases; mispositioned catheter and uninterpretable manometry tracings accounted for the remaining 3/70 (4%) cases. There were no instances of equipment damage or patient safety incidents. Conclusion: Our study demonstrated that a “one stop shop” esophageal motility protocol during propofol endoscopy was safe, feasible and highly convenient for patients due to consolidation of care and avoidance of unsedated trans-nasal placement of manometry catheters.