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PubMed1991

[Intraoperative esophageal manometry].

Intra-operative esophageal electromanometry (IEM), a method foretold by the authors since 1972, is indicated in the course interventions for functional esophageal disease. The main application of IEM occurs in the presence of myotomy and in the preparation of anti-reflux plasty. As far as myotomy is concerned, IEM can provide guidance in identifying a site for future intervention and, once accomplished, for documenting the completeness thereof. As far as anti-reflux plasty is concerned, it provides an opportunity to verify the onset of an anti-reflux high-pressure zone (nHPZ) that can be calibrated fittingly until the required values are achieved. IEM appears especially useful in effecting a Nissen fundoplication, the frightful complications of which compel many a surgeon to use other types of plasty, despite the lower rate of effectiveness. The perfect identity between the degree of loop closing and the manometric values obtained, and between the loop width and the length of the nHPZ, obtainable through Nissen's fundoplication only, testifies in favor of the use of IEM in preparation of this type of fundoplication only. The Authors present their case studies from 1985 to date, collected at the Service of Surgical Esophagology of the Faculty of Naples, covering 145 cases of Nissen's fundoplication, 70 of which after extramucosal cardias myotomy according to Heller, 54 cases of GER, including 2 cases of scleroderma, epiphrenic diverticula, DES and repeated surgery.

Esophageal Motility Disorders↗
PubMed1990

Radionuclide esophageal transit study in detection of esophageal motor dysfunction: comparison with motility studies (manometry)

Radionuclide esophageal transit study (RETS) has been developed to assess motor function of the esophagus. The purpose of this study was to compare RETS to esophageal motility studies (EMS) in detection of motility disorders. A total of 109 consecutive patients without previous history of surgery on the esophagus underwent both RETS and EMS within one month of each other. Final diagnosis was divided into three categories: I--primary esophageal motor disorders (n = 39); II--reflux disease (n = 48); and III--non-cardiac chest pain and/or dysphagia (n = 22). Using EMS as the standard, the results of RETS were as follows: sensitivity for detection of motor dysfunction was 97%, 92%, and 77% for Groups I, II, and III, respectively, while specificity was 91% for Group II and 100% for Group III. Global sensitivity was 92% and specificity was 88%. No clinically significant motor disorders were missed by RETS. In conclusion, RETS is a useful noninvasive test for the screening of patients with symptoms thought to be of esophageal origin.

Adult↗
PubMed1990

[The effect of a histamine nasal provocation tests on the results of the tubal compliance manometry test (TCM) in normal study subjects].

The Tubal-compliance-manometric test (TCM) assesses the passive and active tubal opening as well as the equilibration ability. The pressures necessary to open the eustachian tube (ET) are measured while performing the Valsalva maneuver and during swallowing (if needed with added pressure). The equilibration ability is also checked. Subjects with normal tympanometry were twice tested, at an interval of 1 to 2 weeks; 52 ETs (in 28 persons) entered the study. According to a variance analysis (ANOVA), there was no significant difference (alpha = 5%) between the two measurements (the results were time-independent). The mean opening pressures were 610 daPa (SD = 108) during the Valsalva maneuver and 97 daPa (SD = 40) during the swallow test. Nearly 14% of the tubes were considered floppy (unable to maintain a positive pressure). In order to study the influence of mucosal swelling on tubal function, 9 subjects (18 tubes) underwent a TCM before and after a nasal histamine provocation. The opening pressures in both tests were significantly altered (higher) after the provocation (ANOVA; 0.001 less than p less than 0.01). One tube became obstructed and two became floppy. The equilibration ability was not altered. The TCM proved to be of value as an easy, fast and quantitative test for assessing active and passive tubal function.

Acoustic Impedance Tests↗