High resolution esophageal manometry versus standard esophageal manometry: costs and efficiency

Background: Esophageal manometry (EM) is the investigation that allows the evaluation of esophageal motility from the upper esophageal sphincter to the body and lower esophageal sphincter. With standard or conventional manometry (CM) this elements are assessed one at a time. High resolution esophageal manometry (HREM) offers a simultaneous "map" of the pressures of the entire esophagus. The aim of this study was to compare in terms of costs and efficiency standard manometry and HREM. Methods: We compared several cost related characteristics of CM and HREM in a tertiary center with both methods available. Efficiency was defined as a function of time needed to perform one exam and time needed to establish the final diagnosis. Results: In terms of costs, HREM is more expensive. However there are some elements (like the fast calibration of the probe, less technical difficulties) that makes it more appealing. With the development of HREM, in the last years esophageal motility disorders were reclassified and redefined several times, based on some metric parameters, which are more difficult to determine with CM. In terms of efficiency, CM requires 3540 minutes/patient compared with a HREM study that takes up to 15 minutes. In addition, the display of esophageal motility in a spatiotemporal representation of pressures, allows a rapid diagnosis. Conclusions: HREM is expensive, but less time consuming when compared with standard EM. It is a useful tool in tertiary centers with a high number of patients with esophageal motility disorders.