Guidewire-assisted placement of water-perfused esophageal high-resolution manometry probe when gastric insertion fails: A single-center experience

Background Blind positioning of a high-resolution manometry (HRM) probe across the esophagogastric junction (EGJ) is not always possible. We report our experience using guidewire-assisted water-perfused HRM probe insertion when the EGJ could not be traversed. Methods Retrospective study analyzing the failure rate of EGJ insertion during HRM, and reporting a series of guidewire-assisted procedures. Key Results Among 2727 HRM procedures, the failure rate for traversing the EGJ was 2.7% (73 patients). The technique of guidewire-assisted placement of the HRM probe was used in 25 patients; it was well-tolerated and successful in all patients. No motility disorder was found in 6 patients. In four patients with previously diagnosed achalasia, achalasia subtype changed to type III in one patient. While a suspected motility disorder at barium esophagram and/or initial imperfect HRM tracing was confirmed in 10 patients, a new motility disorder was diagnosed in five patients using guidewire-assisted placement of the HRM probe. Conclusions and Inferences In cases of inability to traverse the EGJ, insertion of a water-perfused HRM probe using an endoscopically-placed nasogastric guidewire allows successful EGJ and esophageal peristalsis assessment. Although motility disorders are often suspected using alternative diagnostic modalities, guidewire-assisted placement of HRM may be helpful for revealing them in patients where alternative diagnostic modalities are either unavailable or inconclusive.

Automated summary

This study retrospectively analyzed the failure rate of esophagogastric junction (EGJ) insertion during high-resolution manometry (HRM) and reported the use of guidewire-assisted procedures. The results showed that insertion of a water-perfused HRM probe using an endoscopically-placed nasogastric guidewire allowed successful assessment of EGJ and esophageal peristalsis in cases where EGJ traversal was not possible.