The clinical usefulness of high-resolution manometry for the management of achalasia

Abstract

Introduction: For many years, the assessment of esophageal motility relied on conventional manometry, typically performed through catheters with limited spatial resolution (pressure transducers spaced 5 cm apart). High-resolution manometry (HRM) uses a large number of closely spaced pressure sensors. This arrangement enables continuous monitoring of the entire pressure profi le from the pharynx to the stomach. Advances in computer processing have allowed this increased amount of data to be displayed as spatiotemporal plots rather than simple line graphs; these HRM pressure topography plots are considered more intuitive and may decrease interpretation time, and they provide a simpler and faster way to perform manometry because the “pull through” required to identify the lower esophageal sphincter and position the conventional manometry catheter is obviated [1]. Moreover, HRM provides accurate measurement of the esophageal sphincters in the presence of esophageal shortening or catheter displacement because the closely spaced sensors provide continuous monitoring of all pressure zones. Finally, HRM pressure topography can distinguish between luminal pressurization due to muscular contractions and that caused by retained bolus material [2]. Studies in healthy volunteers recently have defi ned normal fi ndings for esophageal peristalsis [3] and esophagogastric junction dynamics [4], and a classifi cation of esophageal motility disorders based on pressure topography has begun to take shape [5]. This classifi cation includes three achalasia subtypes based on HRM topography fi ndings in the esophageal body: negligible pressurization, pan-esophageal pressurization, and spastic contractions. Understandably, HRM has generated much enthusiasm. However, studies clearly documenting the advantages of this technique over conventional manometry in the clinical setting have been lacking. The study discussed here by Pandolfi no et al. addresses the usefulness of HRM in the management of achalasia.