High-Resolution Manometry with Solid Provocative Test in Patients with Mid-Thoracic and Epiphrenic Esophageal Diverticula.

Loris Baravian,Chloé Melchior, Sofia Hambli,Julien Branche,Romain Gérard,Fabien Wuestenberghs, Guillaume Piessen, Guillaume Gourcerol,Pauline Wils

Neurogastroenterology and motility（2025）

Department of Gastroenterology

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Abstract

BACKGROUND:The number of studies exploring esophageal motility disorders using high-resolution manometry (HRM) in patients with esophageal diverticula (ED) is limited. The goal of this study was to describe motility disorders using HRM in patients with ED and assess the added value of provocative testing in these patients. METHODS:Patients with ED who underwent HRM between 2010 and 2022 were retrospectively included. HRM findings were compared based on single water swallows (SWS), and provocative testing with solid food swallows in the upright seated position, using both ManoView and Medical Measurement Systems software. We also calculated median pressure slopes during the compartmentalization phase. KEY RESULTS:Sixteen of the 39 included patients had mid-ED and 23 had lower ED. Twenty (51.3%) patients had motility disorders based on SWS, including 7 (18%) with achalasia and 3 (7.7%) with esophagogastric junction obstruction. No significant differences in esophageal motility disorders were observed in relation to the location of the ED. Solid food swallows were performed in 29 (74%) patients leading to a change in the HRM diagnosis in 7 (24.1%), all of whom showed elevated IRP. Median pressure slopes during the compartmentalization phase (n = 30) were elevated in patients both with and without motility disorders. CONCLUSION AND INFERENCES:Half of the patients with mid- or lower ED had motility disorders on HRM. Adding solid food swallows during HRM in patients with ED improves the manometric diagnosis. Results suggest abnormal distensibility in these patients, indicated by elevated pressure slope, regardless of the presence of associated motility disorders.

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【要点】：本研究利用高分辨率测压技术（HRM）结合固体食物激发测试，探讨了食管憩室患者中的食管动力障碍，发现该方法可提高诊断准确性并揭示食管扩张性异常。

【方法】：通过回顾性分析2010年至2022年间进行HRM的食管憩室患者数据，对比单一水吞咽（SWS）和直立坐位下固体食物吞咽的HRM结果。

【实验】：共纳入39名患者，其中16名患有中段食管憩室，23名患有下段食管憩室。通过ManoView和Medical Measurement Systems软件分析数据，发现20名（51.3%）患者存在动力障碍，固体食物吞咽测试中有7名（24.1%）患者的HRM诊断发生改变，且所有这些患者均显示升高的一过性食管下括约肌压力（IRP）。此外，分析了30名患者在分隔阶段的压力斜率，发现无论是否存在动力障碍，患者的压力斜率均升高。