IMPACT OF NEW TECHNOLOGIES ON
CLINICAL MANAGEMENT:
HIGH RESOLUTION MANOMETRY
LUIGI BENINI
Gastroenterologia, Dip.Medicina, Università di Verona
Prof Marcello Tonini
HIGH RESOLUTION MANOMETRY
(HRM)

An evolution of time-honored manometry

At least 20 closely spaced recording sites

Possible for technical improvements of

catethers
 Pneumohydraulic
 Hardware
analysis
pumps
and software for data recording, storage and
Solid state catethers
Perfused catethers
High resolution tracings
Dr Clouse
advantages

Motor activity recorded as a continuum

Better spatial resolution

All the viscus is considered at the same time

Pseudo-three dimensional graphs
 better

understanding
easier transfer of results to patients or
referring physicians
One glance evaluation
UES
UES
Better spatial resolution?

Normali:





Aperistalsi
Peristalsi ipotensiva:





normale CFV (Contractil front velocity, < 8 cm/s),
Distal contractile index medio tra 5000 e < 8000 mmHg s*cm*
Pressione postrilassamento del LES > 180 mmHg
Esofago a schiaccianoci:



Intermittente: peristalsi ipotensiva o assente 30-69%
Frequente: peristalsi fallita o ipotensiva >70%
Peristalsi ipertensiva:


P-LES (10-35 mmHg) e rilasciamento
velocità peristaltica CFV (< 8 cm/s) in >90% delle deglutizioni
Indice di contrattilità distale medio < 5000 mmHg s*cm*
Normale CFV (Contractil front velocity),
Distal contractile index medio > 8000 mmHg s*cm*
Spasmo esofageo:CFV > 8 cm/s in ≥ 20% delle deglutizioni.



Acalasia:




diffuso: segmenti medio (S2) e distale (S3)
segmentale: segmenti medio (S2) o distale (S3)
Classica
Con compressione esofagea
Vigorosa
Ostruzione funzionale del LES
Chicago 2009
CLASSIFICAZIONE
TRADIZIONALE
normale
HRM (Chicago 2009)
normale
IOM 1 ( Peristalsi inefficace lieve)
Peristalsi ipotensiva intermittente
IOM 2( Peristalsi inefficace severa)
Peristalsi ipotensiva frequente
Acalasia classica
Acalasia
Acalasia con compressione esofagea
Acalasia vigorosa
Spasmo esofageo diffuso
Spasmo esofageo
Spasmo esofageo segmentale
Schiaccianoci (nutcracker)
Schiaccianoci (Nutcracker)
Alterazioni aspecifiche prossimali
Alterazioni striato
tradizionale
norm
norm
IOM 2
Spasm
1
4
3
aspec
prox
Non
classif.
4
3
1
8
HRM
1
10
8
1
9
3
4
1
1
1
1
2
1
non
classif.
tot
tot
1
nutcr
striato
Nutcr
16
acal
spasm
acal
16
ipotens
interm
ipotens
freq
IOM 1
4
0
19
8
6
9
0
1
3
6
34/52
CONCLUSIONS

HRM vs traditional manometry
Better spatial resolution
 Possible evaluation of

 proximal
segments
 cohordination

Easier transferral of results
Prognostic implications in achalasia?
 But

cost-benefit ratio unknown
 Better diagnostic capacity; what about therapy?
