Читать книгу The Esophagus - Группа авторов - Страница 216

Since a primary objective of HRM is to detect primary esophageal motor disorders, it should follow an evaluation for mechanical obstruction (e.g. stricture, severe erosive esophagitis, large hiatal hernia, tumor). While identification of any of these often negates the need for esophageal manometry, if manometry is completed, the interpretation should so specify, reporting any findings as secondary motor findings. Previous foregut surgery (e.g. fundoplication, adjustable gastric band, LES‐myotomy, etc.) may also induce secondary motor abnormalities, making the surgical history an essential element of the interpretation. Similarly, medications such as anticholinergics, nitrates, calcium channel blockers, and opioids can have effects on esophageal motility [14, 15]. Hence, a medication list should be reviewed prior to manometry, and, if possible, non‐essential medications with potential for impact on esophageal motility should be held prior to manometry.

The manometry test is performed after at least a 6 hr fast; longer fasting periods or a liquid diet for one or two days prior to the manometry should be considered in patients with suspected achalasia or significant esophageal retention. Immediately prior to the manometry test, the manometry assembly should be calibrated according to manufacturer instructions. All test materials should be organized within close reach; this includes tape strips to secure the manometry catheter, substances for test swallows (liquid, bread) and delivery (syringe, straw), and also an emesis basin (cough, gagging, spitting, and vomiting sometimes occur). The patient’s chest should be covered with a chux pad or gown. We have the patient hold a cup of water with a straw to drink from, to assist in placing the manometry catheter.