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Steven R. Demeester - One of the best experts on this subject based on the ideXlab platform.
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The Value of High-Resolution Manometry in the Assessment of the Resting Characteristics of the Lower Esophageal Sphincter
Journal of Gastrointestinal Surgery, 2009Co-Authors: Shahin Ayazi, Jeffrey A. Hagen, Joerg Zehetner, Oliver Ross, Arzu Oezcelik, Emmanuele Abate, Helen J. Sohn, Farzaneh Banki, John C. Lipham, Steven R. DemeesterAbstract:Introduction High-resolution Manometry (HRM) is faster and easier to perform than conventional water perfused Manometry. There is general acceptance of its usefulness in evaluating upper esophageal sphincter and esophageal body. There has been less emphasis on the use of HRM to evaluate the lower esophageal sphincter (LES) resting pressure and length, both factors important in LES barrier function. The aim of this study was to compare the resting characteristics of the LES determined by HRM and conventional Manometry in the same patients. Methods We performed both HRM and conventional Manometry including a slow motorized pull-through technique in 55 patients with foregut symptoms. The characteristics of the LES analyzed were: resting pressure, total length, and abdominal length. Four available modes of HRM analysis were used to assess resting characteristics of the LES: spatiotemporal mode using both abrupt color change and isobaric contour, line tracing, and pressure profile. The values obtained from these four HRM modes were then compared to the conventional Manometry measurements. Results High-resolution Manometry and conventional Manometry did not differ in their measurement of LES resting pressure. LES overall and abdominal length were consistently overestimated by HRM. A variability up to 4 cm in overall length was observed and was greatest in patients with hiatal hernia (1.8 vs. 0.9 cm, p = 0.027). Conclusion The current construction of the catheter and software analysis used in high-resolution Manometry do not allow precise measurement of LES length. Errors in the identification of the upper border of the sphincter may compromise accurate positioning of a pH probe.
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the value of high resolution Manometry in the assessment of the resting characteristics of the lower esophageal sphincter
Journal of Gastrointestinal Surgery, 2009Co-Authors: Shahin Ayazi, Jeffrey A. Hagen, Joerg Zehetner, Arzu Oezcelik, Emmanuele Abate, Helen J. Sohn, Farzaneh Banki, John C. Lipham, Oliver N Ross, Steven R. DemeesterAbstract:Introduction High-resolution Manometry (HRM) is faster and easier to perform than conventional water perfused Manometry. There is general acceptance of its usefulness in evaluating upper esophageal sphincter and esophageal body. There has been less emphasis on the use of HRM to evaluate the lower esophageal sphincter (LES) resting pressure and length, both factors important in LES barrier function. The aim of this study was to compare the resting characteristics of the LES determined by HRM and conventional Manometry in the same patients.
Marco G. Patti - One of the best experts on this subject based on the ideXlab platform.
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VALIDATION OF A NEW WATER-PERFUSED HIGH-RESOLUTION Manometry SYSTEM.
Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery, 2021Co-Authors: Rogério Mariotto, Fernando A. M. Herbella, Vera Lucia Ângelo Andrade, Francisco Schlottmann, Marco G. PattiAbstract:BACKGROUND Water-perfused high resolution Manometry system. High-resolution Manometry is more costly but clinically superior to conventional Manometry. Water-perfused systems may decrease costs, but it is unclear if they are as reliable as solid-state systems, and reference values are interchangeable. AIM To validate normal values for a new water-perfusion high-resolution Manometry system. METHODS Normative values for a 24-sensors water perfused high-resolution Manometry system were validated by studying 225 individuals who underwent high resolution Manometry for clinical complaints. Patients were divided in four groups: group 1 - gastroesophageal reflux disease; group 2 - achalasia; group 3 - systemic diseases with possible esophageal manifestation; and group 4 - dysphagia. RESULTS In group 1, a hypotonic lower esophageal sphincter was found in 49% of individuals with positive 24 h pH monitoring, and in 28% in pH-negative individuals. In groups 2 and 3, aperistalsis was found in all individuals. In group 4, only one patient (14%) had normal high-resolution Manometry. CONCLUSIONS The normal values determined for this low-cost water-perfused HRM system with unique peristaltic pump and helicoidal sensor distribution are discriminatory of most abnormalities of esophageal motility seen in clinical practice.
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Can high resolution Manometry parameters for achalasia be obtained by conventional Manometry
World journal of gastrointestinal pathophysiology, 2015Co-Authors: Fernando A. M. Herbella, Marco G. PattiAbstract:High resolution Manometry (HRM) is a new technology that made important contributions to the field of gastrointestinal physiology. HRM showed clear advantages over conventional Manometry and it allowed the creation of different manometric parameters. On the other side, conventional Manometry is still wild available. It must be better studied if the new technology made possible the creation and study of these parameters or if they were always there but the colorful intuitive panoramic view of the peristalsis from the pharynx to the stomach HRM allowed the human eyes to distinguish subtle parameters unknown or uncomprehend so far and if HRM parameters can be reliably obtained by conventional Manometry and data from conventional Manometry still can be accepted in achalasia studies. Conventional Manometry relied solely on the residual pressure to evaluate lower esophageal sphincter (LES) relaxation while HRM can obtain the Integrated Relaxation Pressure. Esophageal body HRM parameters defines achalasia subtypes, the Chicago classification, based on esophageal pressurization after swallows. The characterization of each subtype is very intuitive by HRM but also easy by conventional Manometry since only wave amplitudes need to be measured. In conclusion, conventional Manometry is still valuable to classify achalasia according to the Chicago classification. HRM permits a better study of the LES.
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High-resolution Manometry for the evaluation of gastric motility
Updates in Surgery, 2014Co-Authors: Fernando Augusto Mardiros Herbella, Lilian R. O. Aprile, Marco G. PattiAbstract:This review focus on the utility of HRM for the evaluation of gastric motility. The evaluation of gastric motility has clinical implications for the study of a myriad of diseases. Disordered motility represents a spectrum of dysfunction ranging from delayed gastric emptying to abnormally rapid gastric transit. Gastric motility may be measured by a variety of methods with different efficacy and different variables that may be obtained. High-resolution Manometry was created and added to the diagnostic armamentarium. The methods and outcomes for the study of proximal motility that may be useful to assess the thoracoabdominal pressure gradient, gastric filling and accommodation are described. Also, studies on antroduodenal Manometry are reviewed. High-resolution Manometry allows gastric Manometry without technical limitations found on conventional Manometry; however, studies are still on the phase of understanding the normal findings.
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Upper esophageal sphincter resting pressure varies during esophageal Manometry
Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery, 2014Co-Authors: Daniel Tavares Rezende, Fernando A. M. Herbella, Luciana C. Silva, Sebastião Panocchia-neto, Marco G. PattiAbstract:BACKGROUND: The upper esophageal sphincter is composed of striated muscle. The stress of intubation and the need to inhibit dry swallows during an esophageal Manometry test may lead to variations in basal pressure of this sphincter. Upper esophageal sphincter is usually only studied at the final part of the test. Was observed during the performance of high resolution Manometry that sphincter pressure may vary significantly over the course of the test. AIM: To evaluate the variation of the resting pressure of the upper esophageal sphincter during high resolution Manometry. METHODS: Was evaluated the variation of the basal pressure of the upper esophageal sphincter during high resolution Manometry. Were reviewed the high resolution Manometry tests of 36 healthy volunteers (mean age 31 years, 55% females). The basal pressure of the upper esophageal sphincter was measured at the beginning and at the end of a standard test. RESULTS: The mean time of the test was eight minutes. The basal pressure of the upper esophageal sphincter was 100 mmHg at the beginning of the test and 70 mmHg at the end (p
Shahin Ayazi - One of the best experts on this subject based on the ideXlab platform.
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The Value of High-Resolution Manometry in the Assessment of the Resting Characteristics of the Lower Esophageal Sphincter
Journal of Gastrointestinal Surgery, 2009Co-Authors: Shahin Ayazi, Jeffrey A. Hagen, Joerg Zehetner, Oliver Ross, Arzu Oezcelik, Emmanuele Abate, Helen J. Sohn, Farzaneh Banki, John C. Lipham, Steven R. DemeesterAbstract:Introduction High-resolution Manometry (HRM) is faster and easier to perform than conventional water perfused Manometry. There is general acceptance of its usefulness in evaluating upper esophageal sphincter and esophageal body. There has been less emphasis on the use of HRM to evaluate the lower esophageal sphincter (LES) resting pressure and length, both factors important in LES barrier function. The aim of this study was to compare the resting characteristics of the LES determined by HRM and conventional Manometry in the same patients. Methods We performed both HRM and conventional Manometry including a slow motorized pull-through technique in 55 patients with foregut symptoms. The characteristics of the LES analyzed were: resting pressure, total length, and abdominal length. Four available modes of HRM analysis were used to assess resting characteristics of the LES: spatiotemporal mode using both abrupt color change and isobaric contour, line tracing, and pressure profile. The values obtained from these four HRM modes were then compared to the conventional Manometry measurements. Results High-resolution Manometry and conventional Manometry did not differ in their measurement of LES resting pressure. LES overall and abdominal length were consistently overestimated by HRM. A variability up to 4 cm in overall length was observed and was greatest in patients with hiatal hernia (1.8 vs. 0.9 cm, p = 0.027). Conclusion The current construction of the catheter and software analysis used in high-resolution Manometry do not allow precise measurement of LES length. Errors in the identification of the upper border of the sphincter may compromise accurate positioning of a pH probe.
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the value of high resolution Manometry in the assessment of the resting characteristics of the lower esophageal sphincter
Journal of Gastrointestinal Surgery, 2009Co-Authors: Shahin Ayazi, Jeffrey A. Hagen, Joerg Zehetner, Arzu Oezcelik, Emmanuele Abate, Helen J. Sohn, Farzaneh Banki, John C. Lipham, Oliver N Ross, Steven R. DemeesterAbstract:Introduction High-resolution Manometry (HRM) is faster and easier to perform than conventional water perfused Manometry. There is general acceptance of its usefulness in evaluating upper esophageal sphincter and esophageal body. There has been less emphasis on the use of HRM to evaluate the lower esophageal sphincter (LES) resting pressure and length, both factors important in LES barrier function. The aim of this study was to compare the resting characteristics of the LES determined by HRM and conventional Manometry in the same patients.
John O. Clarke - One of the best experts on this subject based on the ideXlab platform.
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The role of ambulatory 24-hour esophageal Manometry in clinical practice.
Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society, 2020Co-Authors: Afrin Kamal, John O. Clarke, Jac Oors, Albert J BredenoordAbstract:High-resolution Manometry revolutionized the assessment of esophageal motility disorders and upgraded the classification through the Chicago Classification. A known disadvantage of standard HRM, however, is the inability to record esophageal motility function for an extended time interval; therefore, it represents only a more snapshot view of esophageal motor function. In contrast, ambulatory esophageal Manometry measures esophageal motility over a prolonged period and detects motor activity during the entire circadian cycle. Furthermore, ambulatory Manometry has the ability to measure temporal correlations between symptoms and motor events. This article aimed to review the clinical implications of ambulatory esophageal Manometry for various symptoms, covering literature on the Manometry catheter, interpretation of findings, and relevance in clinical practice specific to the evaluation of non-cardiac chest pain, chronic cough, and rumination syndrome.
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three dimensional anorectal Manometry enhances diagnostic gain by detecting sphincter defects and puborectalis pressure
Digestive Diseases and Sciences, 2017Co-Authors: Shreya Raja, Francis Okeke, Ellen M Stein, Sameer Dhalla, Monica Nandwani, Kristle Lynch, Prakash C Gyawali, John O. ClarkeAbstract:Background Constipation and fecal incontinence (FI) are common and are often evaluated with anorectal Manometry. Three-dimensional high-resolution anorectal Manometry (HRAM) is a promising technology; however, implementation has been limited by lack of metrics and unclear clinical utility.
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High-resolution Manometry.
Annals of the New York Academy of Sciences, 2011Co-Authors: John O. Clarke, C. Prakash Gyawali, Roger P. TatumAbstract:The following presents commentaries on the interest of high-resolution Manometry for understanding the anatomy and physiology of the esophagogastric junction; the subtypes of achalasia, as diagnosed by high-resolution Manometry; the interest of high-resolution Manometry in the evaluation of dysphagia following fundoplication; and the appropriate clinical protocol for high-resolution Manometry.
James Toouli - One of the best experts on this subject based on the ideXlab platform.
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scintigraphy versus Manometry in patients with suspected biliary sphincter of oddi dysfunction
Gut, 2003Co-Authors: A. Craig, D Peter, Gino T P Saccone, Patrick Ziesing, Allan G Wycherley, James ToouliAbstract:Introduction: Sphincter of Oddi (SO) Manometry is at present the "gold standard" investigation for patients with suspected biliary SO dysfunction. Non- invasive scintigraphy in cholecystectomised patients using a complex scoring system or the transit time from the hepatic hilum to the duodenum (HDTT) have been promoted as sensitive and specific alternatives. Aim: To evaluate the scintigraphic scoring system and HDTT in patients with suspected biliary SO dys- function undergoing SO Manometry. Methods: Cholecystectomised patients undergoing SO Manometry for persistent biliary-type pain, as defined by the Rome II criteria, for which all other causes had been excluded, were prospectively stud- ied. Scintigraphy with cholecystokinin octapeptide infusion was performed within a month prior to Manometry. Scoring of the scans and measurement of HDTT was performed by independent blinded observers. Manometry of the biliary sphincter was performed per-endoscopically and defined as abnormal if basal pressure was > 40 mm Hg. Results: Thirty two patients were enrolled (30 females, mean age 45.1 years). Three patients were excluded from analysis because Manometry from the bile duct was not technically possible. Eight patients had abnormal Manometry. Scintigraphic scoring had a sensitivity of 25-38%, a specificity of 86-89%, positive predictive value (PPV) of 40-60%, and a negative predictive value (NPV) of 75-79%. The coefficient of variation for interobserver variation in scores was 0.72. HDTT sensitivity was 13%, specificity 95%, PPV 50%, and NPV 74%. Conclusions: Our findings indicate that scintigraphy using these methods of analysis correlates poorly with Manometry in post cholecystectomy patients with suspected biliary SO dysfunction.
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Investigation of sphincter of Oddi dysfunction
Hpb, 1999Co-Authors: A. Craig, James ToouliAbstract:Background Sphincter of Oddi dysfunction (SOD) is characterised by either recurrent biliary-type pain, or recurrent pancreatitis. Objective assessment and diagnosis is important, as treatment is often difficult and should be reserved for those patients with an objectively-demonstrated sphincter of Oddi (SO) abnormality. Methods This review considers methods currently used to investigate SOD, including SO Manometry, scintigraphy, US and the Nardi test. It also discusses new techniques, or refinements of existing methods, which may assist in the diagnosis and management of this condition. Results SO Manometry only samples SO activity and routinely occurs in a non-physiological setting. Recent refinements in catheter design may allow prolonged Manometry to be more widely considered. Biliary scintigraphy allows the non-invasive assessment of bile flow, possibly with higher sensitivity and specificity than Manometry. US demonstrates gross pathology, but not subtle changes. The Nardi test poorly predicts the outcome of therapy. Discussion Scintigraphy may well become the initial investigation in the diagnosis of SOD, with SO Manometry being reserved for uncertain cases. Other techniques, such as botulinum toxin injection and common bile duct SO stenting may also warrant further evaluation.