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Artifacts in esophageal high resolution manometry

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Artifacts in esophageal high resolution manometry

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Artifacts in esophageal high resolution manometry

  1. 1. Artifacts in esophageal high resolution manometry Samir Haffar M.D.
  2. 2. Artifacts in esophageal high resolution manometry • Normal esophageal HRM at rest & after wet swallow • Artifacts in HRM: (1) Vascular artifacts (2) Folded catheter artifact (3) Sensor failure artifact (4) Air entrapment artifact
  3. 3. Normal esophageal HRM
  4. 4. Normal esophageal HRM at rest Conklin J et al. ACG Annual Postgraduate Course - October 12-13, 2013 Intra-eophageal pressures decrease in inspiration & increase in expiration
  5. 5. HRM atlas – Medical measurement Systems Normal esophageal HRM after a wet swallow esophageal pressure topography
  6. 6. Normal esophageal HRM after a wet swallow esophageal pressure topography (Clause's segments) Conklin JL. J Neurogastroenterol Motil 2013; 19(3):281-294. 5 ml wet swallow S1: striated esophageal muscles Transition zone: pressure between S1 & S2 S2 & S3: proximal & distal smooth muscles S4: LES repositioning at its resting position
  7. 7. Artifacts in esophageal HRM
  8. 8. Artifacts in esophageal HRM (1) Vascular artifacts (2) Folded catheter artifact (3) Sensor failure artifact (4) Air entrapment artifact
  9. 9. (1) Vascular artifacts
  10. 10. Vascular artifacts Roman S et al. Clin Gastroenterol Hepatol 2011; 9(12): 1050–1055. Vascular artifact observed in the distal esophagus
  11. 11. Potentially useful vascular artifacts Patient complaining of dysphagia Elevated resting intraesophageal pressure at 26 & 31 cm from nares Rhythmic pressure at rate of 80/min (cardiovascular artifacts) Suspicion of dysphagia Lusoria Conklin J, Soffer E, & Pimentel M. Color atlas of high resolution manometry, Springer, 2009.
  12. 12. (2) Folded catheter artifact
  13. 13. Folded catheter artifact / Mirror image Normal peristalsis to about 43 Simultaneous pressure from 43 to 49 cm Reverse peristalsis below 49 cm Pressure from 46-54 mirror image of 38-46 cm Catheter folded upon itself Catheter repositioned to avoid its damage Conklin J, Soffer E, & Pimentel M. Color atlas of high resolution manometry, Springer, 2009.
  14. 14. Folded catheter artifact / Butterfly pattern Gyawali CP et al. Neurogastroenterol Motil 2013; 25:99–133. Catheter coiled in the esophagus Swallow followed by peristaltic esophageal contraction This contraction pattern mirrors at level of curling catheter
  15. 15. (3) Sensor failure artifact
  16. 16. Sensor failure artifact Sensor failure may be seen as solid bands of color (*) or an irregular “chatter” in the color contour (top of the contour) Conklin J, Soffer E, & Pimentel M. Color atlas of high resolution manometry, Springer, 2009.
  17. 17. (4) Air entrapment artifact
  18. 18. Air entrapment artifact Seen when there is air between protective sheath & catheter Very high bolus pressure transmitted all the way to end of catheter (double-headed arrow) Conklin J, Soffer E, & Pimentel M. Color atlas of high resolution manometry, Springer, 2009.
  19. 19. Thank You

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