[Esophageal manometry as a surgical indication in primary esophageal motility disorders]

Today, esophageal manometry is the diagnostic test that enables one to establish a diagnosis of esophageal motor disorder, to make the correct diagnosis among various forms of esophageal motor dyskinesia and to guide the diagnostician, whether physician or surgeon, in making the proper choice of therapy. Achalasia and diffuse esophageal spasm are two of the better known primitive esophageal motor disorders, in which an investigation into motility makes it possible to reach a diagnosis in physiopathological terms and provides guidance in selecting the appropriate therapy. The surgical indications for these two diseases are indeed conditioned significantly by the pre-operative manometric data. The extension of the extramucous esophageal myotomy is in fact guided by the manometric tracing that precisely defines the anatomic and functional boundaries of the motor disorder. Additional support provided by esophageal manometry occurs when there are indications of repeated surgery after myotomy, whether a cardiomyotomy or a long myotomy. In these cases accurate manometry can in fact clarify the origin of the possible post-operative dysphagia and, therefore, the nature of the possible stenosis, functional or organic. It should therefore be emphasized that, as now universally recognized, it would be rather careless today to confront the chapter of functional esophageal disease without the aid of manometry.