Introduction: The insertion of a high-resolution manometry (HRM) catheter into the stomach is essential for accurate manometric diagnoses; however, it is impossible in some cases due to the inability to traverse the esophagogastric junction (EGJ). Predictive factors for these patients have not been investigated in detail, necessitating time-consuming and burdensome procedures for investigators and patients. Therefore, the present study investigated the percentage of and risk factors for failed intubation at the EGJ. Methods: We initially reviewed the medical charts of consecutive HRM procedures performed at our hospital between September 2018 and January 2023. Patient characteristics and the findings of endoscopy and esophagography (where available) were compared between successful and failed procedures. A multivariate logistic regression analysis was conducted to identify predictive factors for the inability to traverse the EGJ. We then validated the predictive factors identified by reviewing consecutive procedures performed between February 2023 and August 2023. Results: Among the 781 procedures performed, 55 (7.0%) failed due to the inability to traverse the EGJ. Achalasia was the most common disorder in these procedures. An older age and dilated esophagus of >34 mm were independent predictive factors for the inability to traverse the EGJ in patients with treatment-naïve achalasia. In the validation study, 7 out of 68 procedures (10.3%) failed due to the inability to traverse the EGJ. A flowchart using the findings of endoscopy and an esophageal diameter of >34 mm predicted the inability to traverse the EGJ with a sensitivity of 71.4% and specificity of 86.9%. Conclusion: Based on an esophageal diameter >34 mm and endoscopic findings, we predicted the inability to traverse the EGJ in more than 70% of patients. A multi-center prospective study is warranted in the future.

1.
Vaezi MF, Pandolfino JE, Yadlapati RH, Greer KB, Kavitt RT. ACG clinical guidelines: diagnosis and management of achalasia. Am J Gastroenterol. 2020;115(9):1393–411.
2.
Cohen DL, Shirin H. Technical success in performing esophageal high-resolution manometry : a review of competency recommendations, predictors of failure, and alternative techniques. Dis Esophagus. 2023;36(8).
3.
Hengehold T, Rogers B, Gyawali CP. Imperfect high-resolution manometry studies: prevalence and predictive factors. Neurogastroenterol Motil. 2022 Jun 1;34(6):e14273.
4.
Roman S, Kahrilas PJ, Boris L, Bidari K, Luger D, Pandolfino JE. High-resolution manometry studies are frequently imperfect but usually still interpretable. Clin Gastroenterol Hepatol. 2011 Dec;9(12):1050–5.
5.
Delbaen C, Gkolfakis P, Devière J, Blero D, Louis H. Guidewire-assisted placement of water-perfused esophageal high-resolution manometry probe when gastric insertion fails: a single-center experience. Neurogastroenterol Motil. 2022;34(9):e14379.
6.
Gurala D, Philipose J, Polavarapu AD, El Douaihy Y, Mulrooney SM. Roth net-assisted endoscopic-guided manometry catheter placement. Cureus. 2020;12(8):e10063.
7.
Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJPM, et al. The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27(2):160–74.
8.
Kuribayashi S, Iwakiri K, Kawada A, Kawami N, Hoshino S, Takenouchi N, et al. Variant parameter values-as defined by the Chicago Criteria-produced by ManoScan and a new system with Unisensor catheter. Neurogastroenterol Motil. 2015;27(2):188–94.
9.
Kuribayashi S, Iwakiri K, Shinozaki T, Hosaka H, Kawada A, Kawami N, et al. Clinical impact of different cut-off values in high-resolution manometry systems on diagnosing esophageal motility disorders. J Gastroenterol. 2019;54(12):1078–82.
10.
Nicodème F, Pipa-Muniz M, Khanna K, Kahrilas PJ, Pandolfino JE. Quantifying esophagogastric junction contractility with a novel HRM topographic metric, the EGJ-Contractile Integral: normative values and preliminary evaluation in PPI non-responders. Neurogastroenterol Motil. 2014 Mar;26(3):353–60.
11.
Iwakiri K, Hoshihara Y, Kawami N, Sano H, Tanaka Y, Umezawa M, et al. The appearance of rosette-like esophageal folds (“esophageal rosette”) in the lower esophagus after a deep inspiration is a characteristic endoscopic finding of primary achalasia. J Gastroenterol. 2010;45(4):422–5.
12.
Hoshikawa Y, Hoshino S, Kawami N, Tanabe T, Hanada Y, Takenouchi N, et al. Possible new endoscopic finding in patients with achalasia: “Gingko leaf sign”. Esophagus. 2020;17(2):208–13.
13.
Minami H, Isomoto H, Miuma S, Kobayashi Y, Yamaguchi N, Urabe S, et al. New endoscopic indicator of esophageal achalasia: “pinstripe pattern”. PLoS One. 2015;10(2):e0101833.
14.
Matsubara H, Ando N, Omura N, Kashiwagi H, Ozawa S, Surgery TK, et al. Descriptive rules for achalasia of the esophagus, June 2012: 4th ed. Esophagus. 2017;14(4):275–89.
15.
Eckardt VF, Aignherr C, Bernhard G. Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology. 1992;103(6):1732–8.
16.
Su H, Carlson DA, Donnan E, Kou W, Prescott J, Decorrevont A, et al. Performing high-resolution impedance manometry after endoscopy with conscious sedation has negligible effects on esophageal motility results. J Neurogastroenterol Motil. 2020;26(3):352–61.
17.
Ortiz V, García-Campos M, Sáez-González E, delPozo P, Garrigues V. A concise review of opioid-induced esophageal dysfunction: is this a new clinical entity?Dis Esophagus. 2018;31(5).
18.
De Leon A, Ahlstrand R, Thörn SE, Wattwil M. Effects of propofol on oesophageal sphincters: a study on young and elderly volunteers using high-resolution solid-state manometry. Eur J Anaesthesiol. 2011;28(4):273–8.
19.
Yoon HJ, Lee JE, Jung DH, Park JC, Youn YH, Park H. Morphologic restoration after peroral endoscopic myotomy in sigmoid-type Achalasia. J Neurogastroenterol Motil. 2020;26(1):67–73.
20.
Schechter RB, Lemme EMO, Novais P, Biccas B. Achalasia in the elderly patient: a comparative study. Arq Gastroenterol. 2011;48(1):19–23.
21.
Grande L, Lacima G, Ros E, Pera M, Ascaso C, Visa J, et al. Deterioration of esophageal motility with age: a manometric study of 79 healthy subjects. Am J Gastroenterol. 1999;94(7):1795–801.
You do not currently have access to this content.