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Optimizing the high-resolution manometry (HRM) study protocol.

A Patel1, A Ding, F Mirza

  • 1Division of Gastroenterology, Washington University School of Medicine, Saint Louis, MO, USA.

Neurogastroenterology and Motility
|January 6, 2015
PubMed
Summary

Moving the landmark phase in high-resolution manometry (HRM) studies to the end improves patient acclimatization and optimizes study duration without affecting interpretation quality.

Keywords:
basal UES pressureesophageal high-resolution manometrylandmark phase

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Area of Science:

  • Gastroenterology
  • Medical Devices
  • Diagnostic Procedures

Background:

  • Esophageal manometry catheter intolerance can prolong high-resolution manometry (HRM) studies and increase patient distress.
  • Assessing the impact of obtaining the landmark phase at the end of the study when the patient has acclimatized to the HRM catheter is crucial.

Purpose of the Study:

  • To evaluate the effect of a modified high-resolution manometry protocol on study duration and patient tolerance.
  • To determine if shifting the landmark phase to the end of the study impacts the quality of diagnostic interpretation.

Main Methods:

  • A study involving 366 patients undergoing esophageal HRM over a 1-year period.
  • Comparison of a standard protocol (landmark phase first) with a modified protocol (landmark phase last).
  • Analysis of study duration, technical characteristics, and motor findings between the two protocols.

Main Results:

  • The modified protocol, used in 10.4% of patients with poor catheter tolerance, resulted in a significantly longer study duration (15.6 min vs. 12.9 min).
  • Despite longer overall duration, the time to complete study maneuvers was not significantly different between protocols.
  • A significant percentage (31.4%) of modified protocol patients could not complete their first maneuver within the standard 95th percentile time (6.1 min).

Conclusions:

  • Modifying the high-resolution manometry protocol by obtaining the landmark phase at the end optimizes study duration.
  • This protocol modification does not compromise the quality of the diagnostic interpretation.
  • The findings suggest a potential improvement in patient experience and study efficiency.