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LUIGI BENINI Gastroenterologia, Dip.Medicina, Università di Verona

IMPACT OF NEW TECHNOLOGIES ON CLINICAL MANAGEMENT: HIGH RESOLUTION MANOMETRY. LUIGI BENINI Gastroenterologia, Dip.Medicina, Università di Verona. Prof Marcello Tonini. HIGH RESOLUTION MANOMETRY (HRM). An evolution of time-honored manometry At least 20 closely spaced recording sites

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LUIGI BENINI Gastroenterologia, Dip.Medicina, Università di Verona

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  1. IMPACT OF NEW TECHNOLOGIES ON CLINICAL MANAGEMENT: HIGH RESOLUTION MANOMETRY LUIGI BENINI Gastroenterologia, Dip.Medicina, Università di Verona

  2. Prof Marcello Tonini

  3. HIGH RESOLUTION MANOMETRY (HRM) • An evolution of time-honored manometry • At least 20 closely spaced recording sites • Possible for technical improvements of • catethers • Pneumohydraulic pumps • Hardware and software for data recording, storage and analysis

  4. Solid state catethers

  5. Perfused catethers

  6. High resolution tracings

  7. Dr Clouse

  8. advantages • Motor activity recorded as a continuum • Better spatial resolution • All the viscus is considered at the same time • Pseudo-three dimensional graphs • better understanding • easier transfer of results to patients or referring physicians

  9. One glance evaluation

  10. UES UES

  11. Better spatial resolution?

  12. Normali: • P-LES (10-35 mmHg) e rilasciamento • velocità peristaltica CFV (< 8 cm/s) in >90% delle deglutizioni • Indice di contrattilità distale medio < 5000 mmHg s*cm* • Aperistalsi • Peristalsi ipotensiva: • Intermittente: peristalsi ipotensiva o assente 30-69% • Frequente: peristalsi fallita o ipotensiva >70% • Peristalsi ipertensiva: • normale CFV (Contractil front velocity, < 8 cm/s), • Distal contractile index medio tra 5000 e < 8000 mmHg s*cm* • Pressione postrilassamento del LES > 180 mmHg • Esofago a schiaccianoci: • Normale CFV (Contractil front velocity), • Distal contractile index medio > 8000 mmHg s*cm* • Spasmo esofageo:CFV > 8 cm/s in ≥ 20% delle deglutizioni. • diffuso: segmenti medio (S2) edistale (S3) • segmentale: segmenti medio (S2) odistale (S3) • Acalasia: • Classica • Concompressione esofagea • Vigorosa • Ostruzione funzionale del LES Chicago 2009

  13. CLASSIFICAZIONE normale

  14. CONCLUSIONS • HRM vs traditional manometry • Better spatial resolution • Possible evaluation of • proximal segments • cohordination • Easier transferral of results • Prognostic implications in achalasia? • But • cost-benefit ratio unknown • Better diagnostic capacity; what about therapy?

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