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Surgical Endoscopy
Published in: Surgical Endoscopy 5/2019

01-05-2019 | 2018 SAGES Oral

Routine esophageal manometry is not useful in patients with normal videoesophagram

Authors: Evan T. Alicuben, Nikolai Bildzukewicz, Kamran Samakar, Namir Katkhouda, Adrian Dobrowolsky, Kulmeet Sandhu, John C. Lipham

Published in: Surgical Endoscopy | Issue 5/2019

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Abstract

Background

Videoesophagram (VEG) and esophageal manometry (EM) are components of the preoperative evaluation for foregut surgery. EM is able to identify motility disorders and diminished contractility that may alter surgical planning. However, there are no clearly defined criteria to guide this. Reliable manometry is not always easily obtained, and therefore its necessity in routine preoperative evaluation is unclear. We hypothesized that if a patient has normal videoesophagram, manometry does not reveal clinically significant esophageal dysfunction.

Methods

We reviewed patients who underwent protocolized videoesophagram and manometry at our institution. Measures of esophageal motility including the mean distal contractile integral (DCI), mean wave amplitude (MWA), and percent of peristaltic swallows (PPS) were analyzed. The Chicago Classification was used for diagnostic criteria of motility disorders. Normal VEG was defined as stasis of liquid barium on less than three of five swallows.

Results

There were 418 patients included. 231 patients (55%) had a normal VEG, and 187 patients (45%) had an abnormal VEG. In the normal VEG group, only 2/231 (0.9%) patients had both abnormal DCI and PPS, 1/231 (0.4%) patients had both abnormal DCI and MWA and no patients had both abnormal MWA and PPS. There were no patients with achalasia or absent contractility and 1 patient with ineffective esophageal motility (IEM) in the normal VEG group. This was significantly different from the abnormal VEG group which included 4 patients with achalasia, 1 with absent contractility and 22 with IEM (p < 0.0001). The negative predictive value of VEG was 99.6% and the sensitivity was 96.4%.

Conclusions

A normal videoesophagram reliably excluded the presence of clinically significant esophageal dysmotility that would alter surgical planning. Routine manometry is not warranted in patients with normal videoesophagram, and should be reserved for patients with abnormal VEG.
Appendix
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Metadata
Title
Routine esophageal manometry is not useful in patients with normal videoesophagram
Authors
Evan T. Alicuben
Nikolai Bildzukewicz
Kamran Samakar
Namir Katkhouda
Adrian Dobrowolsky
Kulmeet Sandhu
John C. Lipham
Publication date
01-05-2019
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 5/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-018-6456-x

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