American Gastroenterological Association medical position statement: Clinical use of esophageal manometry

Abstract

This document presents the official recommendations of the American Gastroenterological Association (AGA) on Clinical Use of Esophageal Manometry. It was approved by the Clinical Practice Committee on October 2, 2004, and by the AGA Governing Board on November 7, 2004. This document presents the official recommendations of the American Gastroenterological Association (AGA) on Clinical Use of Esophageal Manometry. It was approved by the Clinical Practice Committee on October 2, 2004, and by the AGA Governing Board on November 7, 2004. The following recommendations were developed to assist physicians in the appropriate use of esophageal manometry in patient care. These recommendations are an update from previous recommendations published in 1994 and represent the results of meticulous research into areas of controversy from the previous policy statement. In addition, new techniques have evolved that may improve and complement manometric diagnosis. Thus, these recommendations also take into account how these new technologies may alter clinical practice (Table 1).Table 1Summary of the Recommendations for the Clinical Use of Esophageal ManometryManometry indicatedManometry possibly indicatedManometry not indicatedTo establish the diagnosis of dysphagia when obstruction (eg, a stricture) cannot be found. Particularly important if achalasia is suspected.For the preoperative assessment of peristaltic function in patients being considered for antireflux surgery.For making or confirming a suspected diagnosis of gastroesophageal reflux disease.For placement of intraluminal devices (eg, pH probes) when positioning depends on the relationship to functional landmarks, such as the lower esophageal sphincter.For evaluation of dysphagia in patients who have undergone either antireflux surgery or treatment for achalasia.As the initial test for chest pain or other esophageal symptoms because of the low specificity of the findings and the low likelihood of detecting a clinically significant motility disorder.For the preoperative assessment of patients being considered for antireflux surgery if there is any question of an alternative diagnosis, especially achalasia. Open table in a new tab 1Manometry is indicated to establish the diagnosis of dysphagia in instances in which a mechanical obstruction (eg, stricture) cannot be found. This is particularly important if a diagnosis of achalasia is suspected. However, given the low prevalence of achalasia in patients with esophageal symptoms, more common esophageal disorders should be excluded with barium radiographs or endoscopy before manometric evaluation.2Manometric techniques are indicated for placement of intraluminal devices (eg, pH probes) when positioning is dependent on the relationship to functional landmarks, such as the lower esophageal sphincter.3Manometry is indicated for the preoperative assessment of patients being considered for antireflux surgery if there is any question of an alternative diagnosis, especially achalasia. 1Manometry is possibly indicated for the preoperative assessment of peristaltic function in patients being considered for antireflux surgery.2Manometry is possibly indicated to assess symptoms of dysphagia in patients who have undergone either antireflux surgery or treatment for achalasia. 1Manometry is not indicated for making or confirming a suspected diagnosis of gastroesophageal reflux disease.2Manometry should not be routinely used as the initial test for chest pain or other esophageal symptoms because of the low specificity of the findings and the low likelihood of detecting a clinically significant motility disorder.