Esophageal motility
CPT4 code
Name of the Procedure:
Esophageal Motility Study (EMS) Common name(s): Manometry Test, Esophageal Manometry
Summary
An esophageal motility study (EMS) is a diagnostic test that evaluates the movement and pressure inside the esophagus—the tube that carries food from the throat to the stomach. It helps identify disorders related to swallowing and esophageal function.
Purpose
EMS is used to diagnose problems with esophageal motility, such as difficulty swallowing (dysphagia), chest pain, and esophageal spasms. The goals are to identify abnormal patterns of muscle movement and pressure within the esophagus to guide appropriate treatment.
Indications
Symptoms that warrant the procedure include persistent swallowing difficulties, unexplained chest pain, regurgitation of food, and evaluation before anti-reflux surgery. It is often recommended for patients with conditions like achalasia, scleroderma, or other neuromuscular disorders affecting the esophagus.
Preparation
Patients are usually instructed to fast for at least 8 hours before the test. Medications that affect esophageal motility, such as certain muscle relaxants or antacids, may need to be adjusted or stopped as per the doctor's instructions. Pre-procedure assessments may include a review of medical history and previous diagnostic tests, such as endoscopy.
Procedure Description
- The patient is asked to lie down on their side.
- A thin, flexible tube (catheter) is gently inserted through the nose and advanced into the esophagus.
- The catheter is equipped with pressure sensors that measure muscle contractions as the patient swallows small sips of water.
- These measurements are recorded and analyzed to assess esophageal function.
- The catheter is then removed, typically after about 30 to 60 minutes.
Anesthesia or sedation is not usually required, but a local anesthetic may be applied to the nose and throat to minimize discomfort.
Duration
The procedure typically takes about 30 to 60 minutes.
Setting
EMS is performed in a hospital, outpatient clinic, or specialist's office equipped for motility testing.
Personnel
The procedure is usually conducted by a gastroenterologist or a specialized technician, with a nurse assisting.
Risks and Complications
Common risks include mild discomfort, gagging, nasal irritation, and minor nosebleed. Rare complications may include esophageal perforation or severe bleeding. Any complications are managed by the healthcare team present during the procedure.
Benefits
The primary benefit is the accurate diagnosis of esophageal motility disorders, which can lead to more targeted and effective treatments. Patients often receive results within a few days and can begin a tailored treatment plan shortly thereafter.
Recovery
Post-procedure, patients can usually resume normal activities immediately. Mild throat soreness or nasal irritation may occur but typically resolves quickly. Follow-up appointments are scheduled to discuss results and next steps.
Alternatives
Alternative diagnostic options include barium swallow, endoscopy, or pH monitoring. These alternatives may provide different information but are often less specific in diagnosing motility disorders compared to EMS.
Patient Experience
During the procedure, patients might feel slight discomfort or the urge to gag when the catheter is inserted. Breathing is not affected. After the test, mild throat soreness or nasal discomfort can be managed with lozenges or pain relievers if needed. Patients are encouraged to communicate any concerns or discomfort to the healthcare team at any time.