Components of the standard oesophageal manometry

This document originates from several working groups attempting to standardize the performance and interpretation of oesophageal manometry. The authors present an interpretation of the consensus that articulates the established clinical roles for oesophageal manometry and describes the technical components of a basic, standard oesophageal motility examination. Members of the working groups all thought that standardizing oesophageal motility testing is a priority for a number of reasons. Perhaps most important, there is a dearth of standardized training for individual practitioners who perform and interpret oesophageal manometry. Training in these techniques is inadequate in most gastrointestinal (GI) training programmes, and practising clinicians often learn from providers of manometry equipment during brief training sessions. In addition, multiple methods are used for performing and reporting oesophageal manometries, making it difficult or impossible to share data between investigators or clinicians. With the advent of laparoscopic Nissen fundoplication, there has been an explosion of interest in the use of oesophageal manometry as a preoperative diagnostic tool. At the same time, changes in medical practise have placed the conduct of oesophageal manometry into the hands of nurses, medical technicians and others with no prior experience in the techniques or theory of oesophageal manometry. Indeed, their supervising clinicians often have a minimal understanding of oesophageal motor physiology and the technical underpinnings of oesophageal manometry. We have not attempted to address the specific needs for training of the individual performing the tests. It is apparent that these individuals come from a variety of technical or nursing disciplines and are often regulated quite differently by institutional, regional or national licensing authorities. The people undertaking these studies should have a good working knowledge of the principles of oesophageal anatomy and physiology and a thorough understanding of their equipment as a minimum. Participants in our working groups felt that providing a specific and detailed description of the components of a standard oesophageal manometry may help clinical practitioners to perform a standardized and reproducible oesophageal manometry that can be interpreted by others. These guidelines are not meant to supplant the practise of those who have developed their own systems over many years and who are considered experts in the field of oesophageal manometry, nor are they meant to be a detailed, advanced handbook of oesophageal manometry. Those detailed methods can be found in several of the publications or books on the topic. This report comes in three parts: a basic description of the functional information derived from a manometry study, a description of the performance of oesophageal manometry, and a description of the important components of the manometry report. The opinions contained reflect the consensus of the working party derived from the American Motility Society (AMS) and European Society of Neurogastroenterology and Motility Society (ESNM). The conclusions are based on published data and on the combined experience of the participants. Input was also received from several Address for correspondence Dr. Joseph A. Murray, Professor of Medicine, Division of Gastroenterology and Hepatology, The Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. Received: 19 February 2003 Accepted for publication: 13 June 2003 Neurogastroenterol Motil (2003) 15, 591–606