Nasal trumpet harmoniously improves tolerance to high‐resolution impedance manometry catheter placement

Leopold, Andrew R.; Wellington, Jennifer; Jalalian, Aria; Xie, Guofeng

doi:10.1111/nmo.14340

Cited by 3 publications

(6 citation statements)

References 10 publications

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“…A standardized protocol was used for all HREM studies, as previously defined. 13 All patients first gargled 10 mL of 2% lidocaine solution for 10 s. Then Inc.]) was placed (Figure 1A). Diversatek, InSIGHT Ultima or InSIGHT G3 system and HREM catheters (Catalog # UNI-ESO-WG1A1) were used in all patients (Figure 1B).…”

Section: Hrem Protocolmentioning

confidence: 99%

“…8 We described another technique, that is, the use of a nasopharyngeal airway to facilitate the passage of the HREM catheter through the nares. 8,13 The nasopharyngeal airway is a soft, hollow, plastic tubing that runs externally through the nares, terminating in the pharynx. This technique has also been described to diminish coughing and gagging and allow for proper placement of the catheter.…”

Section: Introductionmentioning

confidence: 99%

“…It has been suggested as a next step for HREM catheter placement that can be performed at the bedside during the same patient appointment to troubleshoot failures of HREM catheter upper esophageal sphincter (UES) intubation. 13 However, while the nasopharyngeal airway has been used successfully to place HREM catheters, it has yet to be demonstrated if the placement the nasopharyngeal airway improves rates of procedure completion. This study aims to demonstrate all predictors of HREM catheter placement failure and determine if the nasopharyngeal airway improves technical rates of HREM catheter UES intubation.…”

Section: Introductionmentioning

confidence: 99%

“…This technique has also been described to diminish coughing and gagging and allow for proper placement of the catheter. It has been suggested as a next step for HREM catheter placement that can be performed at the bedside during the same patient appointment to troubleshoot failures of HREM catheter upper esophageal sphincter (UES) intubation 13 . However, while the nasopharyngeal airway has been used successfully to place HREM catheters, it has yet to be demonstrated if the placement the nasopharyngeal airway improves rates of procedure completion.…”

Section: Introductionmentioning

confidence: 99%

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Nasopharyngeal airway assistance improves esophageal intubation rates of high‐resolution esophageal manometry catheters

Leopold,

Wu,

Xie

2024

Neurogastroenterology Motil

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BackgroundHigh‐resolution esophageal manometry (HREM) is the gold standard test for esophageal motility disorders. Nasopharyngeal airway‐assisted insertion of the HREM catheter is a suggested salvage technique for failure from the inability to pass the catheter through the upper esophageal sphincter (UES). It has not been demonstrated that the nasopharyngeal airway improves procedural success rate.MethodsPatients undergoing HREM between March 2019 and March 2023 were evaluated. Chart review was conducted for patient factors and procedural success rates before and after use of nasopharyngeal airway. Patients from March 2019 to May 2021 did not have nasopharyngeal airway available and were compared to patients from May 2021 to March 2023 who had the nasopharyngeal airway available.Key ResultsIn total, 523 HREM studies were conducted; 234 occurred prior to nasopharyngeal airway availability, and 289 occurred with nasopharyngeal airway availability. There was no difference in HREM catheter UES intubation rates between periods when a nasopharyngeal airway attempt was considered procedural failure (85% vs. 85%, p = 0.9). Nasopharyngeal airway use after UES intubation failure lead to improved UES intubation rates (94% vs. 85%, p < 0.01). Thirty‐six patients that failed HREM catheter UES intubation had the procedure reattempted with a nasopharyngeal airway, 30 (83%) of which were successful. The nasopharyngeal airway assisted catheter UES intubation for failures attributed to nasal pain and hypersensitivity, gagging, coughing, and pharyngeal coiling.Conclusions & InferencesUtilization of the nasopharyngeal airway increased rates of UES intubation. When HREM catheter placement through the UES fails, placement of a nasopharyngeal airway can be trialed to overcome patient procedural intolerance.

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Section: Hrem Protocolmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Nasopharyngeal airway assistance improves esophageal intubation rates of high‐resolution esophageal manometry catheters

Leopold,

Wu,

Xie

2024

Neurogastroenterology Motil

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“…16 EGJOO may occur with normal esophageal body peristalsis or alongside other various disorders of major and minor peristalsis, including distal esophageal spasm (DES) and hypercontractile esophagus (HE) and ineffective esophageal motility (IEM). [17][18][19] Reports of EGJOO concurrent with other motility disorders have been estimated to occur in up to 62% of patients, 20 but its clinical significance has yet to be defined. 17 CCv4 currently recognizes that any diagnosis of EGJOO should be reported with a descriptor of the coexisting pattern of esophageal body peristalsis.…”

Section: The Concomitant Findings Of Low Distensibility Index (Di) Onmentioning

confidence: 99%

Major mixed motility disorders: An important subset of esophagogastric junction outflow obstruction

Leopold

Jalalian

Thaker

et al. 2023

Neurogastroenterology Motil

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Background Esophagogastric junction outflow obstruction (EGJOO) is an esophageal motility disorder characterized by a lack of relaxation of the esophagogastric junction (EGJ), with preserved esophageal body peristalsis. We propose new terminology for the coexistence of EGJOO with hypercontractile esophagus and distal esophageal spasm as a major mixed motility disorder (MMMD), and normal peristalsis or a minor disorder of peristalsis such as ineffective esophageal motility with EGJOO as isolated or ineffective EGJOO (IEGJOO). Methods We reviewed prior diagnoses of EGJOO, stratified diagnoses as IEGJOO or MMMD, and compared their symptomatic presentations, high‐resolution manometry (HRM) and endoluminal functional lumen imaging probe (EndoFLIP) metrics, and treatment responses at 2–6 months of follow‐up. Results Out of a total of 821 patients, 142 met CCv3 criteria for EGJOO. Twenty‐two were confirmed by CCv4 and EndoFLIP as having EGJOO and were clinically managed. Thirteen had MMMD, and nine had IEGJOO. Groups had no difference in demographic data or presenting symptoms by Eckardt score (ES). HRM showed MMMD had greater distal contractile integral, frequency of hypercontractile swallows, and frequency of spastic swallows, and greater DI by EndoFLIP. Patients with MMMD showed greater reduction in symptoms after LES‐directed intervention when measured by ES compared with IEGJOO (7.2 vs. 4.0). Conclusion Patients with MMMD and IEGJOO present similarly. Detectable differences in HRM portend different responses to endoscopic therapy. Because patients with MMMD have greater short‐term prognosis, they should be considered a different diagnostic classification to guide therapy.

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Technical success in performing esophageal high-resolution manometry: a review of competency recommendations, predictors of failure, and alternative techniques

Cohen

Shirin

2023

Diseases of the Esophagus

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Esophageal high-resolution manometry (HRM) is the gold standard for diagnosing esophageal motility disorders. As this is performed without sedation, it may be poorly tolerated by patients. Additionally, advancing the catheter tip until the stomach may also be difficult, especially if there is a disease affecting the esophagus or esophagogastric junction which may lead to coiling of the catheter. Currently, there are no guidelines as to who can perform HRM. An expert opinion has recommended minimum numbers of cases for the operator to perform in order to obtain and maintain competency. Several studies have reported on the rates of flawed HRM studies with approximately 20% being imperfect, including about 3% with critical flaws. The presence of a large hiatal hernia and achalasia have been identified as predictors of technical failure. Studies with minor flaws are usually still interpretable and clinically useful. Reports have also described several techniques for sedation-assisted placement of the HRM catheter, and this appears to be a promising alternative in cases of failed HRM, especially as sedation does not appear to significantly affect HRM measurements. An algorithm on how to proceed after a technically imperfect HRM study is proposed. Further research in this field is warranted including confirmation of the recommended competency numbers, assessing for quality measures in performing HRM such as technical success rate, identifying additional predictors of technical failure, standardization of the terminology, and qualifying the benefit of sedation-assisted HRM.

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Nasal trumpet harmoniously improves tolerance to high‐resolution impedance manometry catheter placement

Cited by 3 publications

References 10 publications

Nasopharyngeal airway assistance improves esophageal intubation rates of high‐resolution esophageal manometry catheters

Nasopharyngeal airway assistance improves esophageal intubation rates of high‐resolution esophageal manometry catheters

Major mixed motility disorders: An important subset of esophagogastric junction outflow obstruction

Technical success in performing esophageal high-resolution manometry: a review of competency recommendations, predictors of failure, and alternative techniques

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