Esophageal Manometry: Complete Protocol Guide

Pre-Procedure Requirements

Patient Preparation

• NPO status for 6 hours prior to procedure
• Discontinue medications affecting esophageal motility:
  • Smooth muscle relaxants (48 hours prior)
  • Prokinetics (72 hours prior)
  • PPI therapy (7 days prior if pH testing planned)

Equipment Setup

• Calibrate manometry system
• Verify catheter integrity
• Prepare topical anesthetic
• Ready pressure transducers

Procedure Steps

1. Initial Assessment

• Verify patient identity and consent
• Review relevant medical history
• Document current symptoms
• Explain procedure to patient

2. Catheter Placement

1. Apply topical anesthetic to nostril
2. Insert catheter through nostril at 30° angle
3. Advance slowly with patient sips of water
4. Position sensors across LES
5. Verify placement via pressure topography

3. Recording Protocol

Baseline Measurements

• Record 30-second basal pressure
• Document respiratory pattern

Standard Test Protocol

1. 10 wet swallows

   • 5mL water bolus
   • 30-second intervals
   • Patient supine position

2. Multiple rapid swallows

   • 2mL water × 5 swallows
   • < 4 second intervals

3. Solid swallows (if indicated)

   • Standard viscosity bolus
   • Document timing

Data Analysis

Key Measurements

• Integrated relaxation pressure (IRP)
• Distal contractile integral (DCI)
• Distal latency (DL)
• Break size

Classification

• Apply Chicago Classification v4.0 criteria
• Document any variants
• Note technical limitations

Documentation Requirements

• Complete procedure note
• Technical parameters
• Patient tolerance
• Clinical impressions
• Recommendations

Quality Metrics

• Minimum 7/10 interpretable swallows
• Proper catheter positioning
• Adequate signal quality
• Complete dataset acquisition