High-Resolution Esophageal Manometry: Techniques and Use in the Diagnosis of Esophageal Motility Disorders and for Surgical Decision Making

High-resolution manometry is the gold standard test for evaluation of esophageal motility, which includes both the efficacy of esophageal body contractility and esophagogastric junction relaxation in response to swallowing. It is the best study for the work-up of patients with dysphagia and noncardiac chest pain, in whom a mechanical obstruction has been ruled out via upper endoscopy. As such, manometric parameters form the basis for diagnosis of major and minor esophageal motility disorders, including achalasia. This chapter will describe in detail the technical aspects of performing and analyzing a high-resolution manometry study. The current Chicago Classification of esophageal motility disorders serves as a basis for interpretation of these studies and classification of patients into diagnostic categories. Based on manometric findings, the resulting major and minor motility disorders and their treatments are discussed. Lastly, the use of manometry in the preoperative evaluation of patients with gastroesophageal reflux disease is explored, as well as the use of manometry for selective “tailoring” of fundoplication for patients undergoing antireflux surgery.