Technique of functional and motility test: how to perform antroduodenal manometry

Abstract

Antroduodenal manometry is one of the methods to evaluate stomach and duodenal motility. This test is a valuable diagnostic tool for gastrointestinal motility disorders especially small intestinal pseudo-obstruction which is difficult to make definite diagnosis by clinical manifestations or radiologic findings. Manometric findings that have no evidence of mechanical obstruction and suggestive of pseudo-obstruction with neuropathy or myopathy can avoid unnecessary surgery and the treatment can be directly targeted. Moreover, among patients who have clinically suspected small intestinal pseudo-obstruction but with normal manometric findings, the alternative diagnosis including psychiatric disorder or other organic disease should be considered. The application of this test to the patients with functional gastrointestinal symptoms especially to find the association of motor abnormalities to the symptom has less impressive yield. Antroduodenal manometry is now readily available only in some tertiary care centers. The aim of this review is to describe the antroduodenal manometry technique, interpretation and clinical utility.

Keywords: Gastrointestinal motility; Intestinal pseudo-obstruction; Manometry.

Figure 1

"Fed-response" - a termination of migratory motor complex then irregular and frequent contractions occurred immediately after meal ingestion.

Figure 2

After octreotide injection, phase III antral contractions (at most upper channel) were inhibited but duodenal contractions (lower channels) were stimulated (phase III MMC like activity with rapid propagation).

Figure 3

A case of intestinal pseudo-obstruction - burst of phase II contractions and disorganized phase III migratory motor complex (both antegrade and retrograde phase III MMC) were demonstrated.

Figure 4

A case of chronic vomiting - simultaneous contractions at all sensors which represent abdominal wall contractions were demonstrated of all vomiting events. Rumination syndrome was a final diagnosis in this patient.

Figure 5

A case of severe abdominal pain - retrograde phase III of the fasting migrating motor complex was demonstrated.