UPDATES IN MOTILITY TESTING. Disclosure

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1 UPDATES IN MOTILITY TESTING Shirley Maltman RN CGN(c) June 4, 2016 Disclosure I will be mentioning the Covidien ManoScan manometry system, BRAVO Capsule (also Covidien), and the Crospon EndoFlip system in my presentation as products used by the GI Motility Clinic. There has been no compensation from either company. 1

2 Objectives To state the purpose of the BRAVO Capsule To understand the risks/benefits of the BRAVO capsule To state the purpose and benefits of the EndoFlip Balloon study First a Quick Review 2

3 Why Order the Test? Atypical chest pain Reflux (GERD or NERD) Dysphagia Chronic cough Pre op assessment (Hiatal hernia repair, Fundoplication,Lung transplant) Who Orders ph/motility Studies Gastroenterology General/Thoracic Surgery Respiratory Lung Transplant Team Rheumatology 3

4 Esophageal manometry Normal 4

5 Achalasia Type I Achalasia Type II 5

6 Achalsia Type III Chest pain and dysphagia. Connective Tissue Disease 6

7 Jackhammer Esophagus Formerly known as Nutcracker Esophagus ph Studies All ph studies whether Standard, Impedance, or BRAVO are ordered by the physician based on the information each particular test provides and patient history. (For example, a patient on PPI s would have a ph with Impedance ordered) 7

8 The ph probe Standard 24 Hr. ph Study Usually off PPI for 7 days Used to measure acid reflux Must do Motility Study first to measure position of LES Probe hangs out of nose Usual diet & activity encouraged 8

9 ph/impedance Inserted following Motility study To measure amount of acid or non acid reflux into esophagus over a 24 hr period Probe hangs out of nose. Normal activity and diet encouraged Patient returns the next day for removal (5 10 min visit) Patient can stay on PPI s therefore more comfortable for the patient. Used most commonly 9

10 THE BRAVO CAPSULE BRAVO Capsule on delivery device. Placed after Manometry. EGD MUST be done prior to R/O varices, stricture, and esophagitits. Inserted orally. Done OFF PPI s. 10

11 48 hr BRAVO ph Capsule Positioned 5 cm above proximal edge of LES. BRAVO capsule being attached to esophageal wall by suction and the firing of a pin. Contraindications are: pacemaker/ automatic defibrillator, esophageal varices, bleeding disorders, history of strictures (crohn s and colitis), esophagitis, and uncooperative patient. 11

12 BRAVO capsule in position 5 cm above proximal end of LES This will generally slough off in 3 5 days. Wireless transmission over 48 hours. No one knows that a test is being done. This encourages a more normal activity level and diet during the testing period. They MUST chew very well. A diary is kept by the patient. 12

13 48 hr BRAVO report EndoFlip 13

14 EndoFLIP Endoluminal Functional Lumen Imaging Probe New technology that measures luminal distensibility/compliance We are the only facility in Canada using this technology. ENDOFLIP Used to measure the distensibility of the esophageal lumen Gives us the opposite information of an Esophageal manometry (ie how much does the tissue relax) Usefull in patients with EoE, postfundoplication dysphagia, and Achalasia (preor post myotomy). 14

15 EndoFlip Insertion Inserted orally after Lidocaine spray with balloon in deflated state Patient is in sitting position. Inserted into the stomach with patient sipping water to facilitate advancement. When in the stomach, the balloon is inflated and is pulled into the LES, measurements are taken and the balloon is repositioned for more measurements as required. Oral suctioning as required (controlled by the patient) Balloon is deflated and withdrawn. Time frame 5 15 minutes 15

16 EndoFlip Measuring the distensibility of the LES Esophageal body peristalsis 16

17 What s on the Horizon? Two research studies involving EoE and Scleroderma. 17

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