Technical aspects of clinical high-resolution manometry studies

Background A number of commercial and research systems are available for making high-resolution manometry recordings. Purpose In this document, we review the standard equipment, patient preparation and routine protocol for high-resolution manometry. The major differences between HRM systems lie in the method of signal transduction, with solid-state catheter systems recording form intraluminal transducers and water perfusion systems recording pressures from external transducers via a perfused silicone catheter. The variations in recording systems result in different mechanical and electrical characteristics which dictate different techniques for setting up and using equipment. These issues are relevant in terms of costs and day to day management, but have little clinical significance. After the equipment is prepared for a manometric study, the esophagus is intubated transnasally with the manometric catheter and the catheter is positioned so that the UES and LES/diaphragm are visualized on the recording screen. The subject then undergoes 10 5ml water swallows in the supine position. Manometric data may be integrated with other data streams such as multichannel impedance or images from fluoroscopy to increase the power of the technique in difficult cases