Routine esophageal manometry is not useful in patients with normal videoesophagram

Area of Science:

• Gastroenterology
• Surgical Evaluation
• Esophageal Motility Disorders

Background:

• Videoesophagram (VEG) and esophageal manometry (EM) are key for foregut surgery evaluation.
• EM identifies motility issues impacting surgical plans, but clear criteria are lacking.
• The necessity of routine EM is questioned due to difficulties in obtaining reliable results.

Purpose of the Study:

• To determine if a normal videoesophagram (VEG) can reliably exclude clinically significant esophageal dysmotility.
• To assess the necessity of esophageal manometry (EM) in patients with normal VEG findings prior to foregut surgery.

Main Methods:

• Retrospective review of 418 patients undergoing protocolized VEG and EM.
• Analysis of esophageal motility measures: distal contractile integral (DCI), wave amplitude (MWA), and peristaltic swallows (PPS).
• Utilized Chicago Classification for motility disorders; normal VEG defined by minimal barium stasis.

Main Results:

• Of 418 patients, 231 (55%) had normal VEG. Only 0.9% of normal VEG patients had abnormal DCI and PPS.
• No achalasia or absent contractility found in normal VEG group; only one case of ineffective esophageal motility (IEM).
• Abnormal VEG group showed significantly higher rates of achalasia, absent contractility, and IEM (p < 0.0001). VEG sensitivity was 96.4%, NPV 99.6%.

Conclusions:

• A normal videoesophagram reliably excludes significant esophageal dysmotility relevant to surgical planning.
• Routine esophageal manometry is not indicated for patients with normal VEG.
• Esophageal manometry should be reserved for patients with abnormal VEG findings.