Lessons learned from physician-performed high-resolution esophageal manometries

High-resolution esophageal manometry (HRM) is the gold standard test for evaluation and diagnosis of esophageal motility disorders. While the Chicago Classification offers a standardized protocol for performing and interpreting HRM studies, it does not provide guidance on catheter placement techniques, nor the specific skillset required to conduct the test. At most centers nationally and globally, HRMs are performed by a trained nurse or medical technician. However, in selected centers, physicians perform HRMs alongside a clinical care assistant. Direct physician involvement in performing HRM offers unique clinical insights that can potentially enhance diagnostic accuracy, procedural efficiency, and patient experience. Based on our more than two-decade experience with physician-performed HRMs, we share various tips and techniques to provide step-by-step guidance on performing a high-quality HRM. In addition, we provide reflections from our experience on several benefits of physician-performed manometries including continued continuity of care, real-time interpretation with ability to perform adjunctive testing, and improved patient tolerance.