Nurse

High-Resolution Manometry in the Diagnosis of Esophageal Diseases – Adenocarcinoma of the Esophagus – Case ReportHigh-Resolution Manometry in the Diagnosis of Esophageal Diseases – Adenocarcinoma of the Esophagus – Case Report.

The patient underwent esophageal manometry using a probe (MMS/Laborie, Netherlands). The procedure followed the standard high-resolution manometry protocol, which involved 10 supine wet swallows (5 ml) at 30-second intervals, alongside a multiple rapid swallow sequence.

A 56-year-old patient presented with pronounced dysphagia and suspected achalasia. An initial endoscopy conducted three months earlier at another institution showed difficulty advancing the endoscope 36 cm from the esophagogastric junction (EGJ). The patient was referred to our clinic for esophageal manometry. Manometry findings included the upper esophageal sphincter located at 23.4 cm with a resting pressure of 142 mmHg. The lower esophageal sphincter could not be precisely visualized as the catheter could not pass through the sphincter. The integrated relaxation pressure of the lower esophageal sphincter wasn’t reliable. Distal contractile integral (DCI) was measured at approximately 2680 mmHg·s·cm, likely within a normal range, though pan-esophageal pressurization was noted in each swallow. The multiple water test results were pathological, prompting a recommendation for a repeat endoscopy. A second gastroscopy revealed a circular tumor obstructing the EGJ. Biopsy results confirmed esophageal adenocarcinoma. The patient was hospitalized and, following evaluation and consultation with a thoracic surgeon, underwent a subtotal esophagectomy. Postoperative recovery was uneventful, and the patient was referred for oncological treatment with parenteral nutritional support.

This case illustrates the pivotal role of high-resolution manometry in diagnosing esophageal motility disorders and identifying severe pathologies like malignant tumors. The manometry findings highlighted abnormal changes that necessitated further diagnostic procedures, ultimately leading to the timely identification of esophageal adenocarcinoma. Although the initial suspicion was achalasia, the detailed analysis of symptoms and manometry data enabled accurate diagnosis through targeted endoscopy. This case emphasizes the necessity of an interdisciplinary approach, involving nurses, gastroenterologists, surgeons, pathologists, and nutritionists, to ensure effective management and comprehensive care. Finally, this report underscores the value of educating and supporting patients throughout diagnostic procedures, significantly contributing to successful outcomes. The case demonstrates how advanced diagnostics like high-resolution manometry are critical for precise detection and treatment of complex medical conditions.

 

MissingLinkText

Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
27 March 2025