Top Tweets for #TracingTuesday
@PrasadIyerMD @MayoClinicGIHep @AllonKahn @SongKevinY @ASGEendoscopy Great to see that there is livestream option for those can’t physically attend this world famous course! #gitwitter #tracingtuesday
#TracingTuesday
Giving the above high-resolution manometry (HRM) tracing findings, what would you want to know next for further evaluation?
(2/2)
#TracingTuesday
60 year-old woman with a history of Raynaud’s presents with heartburn, nausea & occasional dysphagia. Upper endoscopy with biopsies were normal. High-resolution esophageal manometry (HRM) was performed.
How would you interpret this HRM tracing?
(1/2)
I had the good fortune of meeting him in Denver when I attended a motility course run my him a few years ago (2014?). What a legend! @AmerGastroAssn #gitwitter #tracingtuesday
In Memoriam—Donald O. Castell, MD https://t.co/DhiAHVABIp
Thank you @TomTielleman for the #TracingTuesday shoutout!
The best part of posting these interesting / challenging manometry tracings is the discussion - so join in on the conversation & share your thoughts!
👉 For previously posted tracings, search the #TracingTuesday hashtag
Local @UTSWNews #GITwitter guru @TomTielleman gave a great talk on Twitter & #MedEd including shout-outs for @DrBloodandGuts @ScopingSundays @MondayNightIBD @WalterChanMD #TracingTuesday and @GiJournal
Local @UTSWNews #GITwitter guru @TomTielleman gave a great talk on Twitter & #MedEd including shout-outs for @DrBloodandGuts @ScopingSundays @MondayNightIBD @WalterChanMD #TracingTuesday and @GiJournal
#TracingTuesday
70 yo man w/ achalasia status post Heller myotomy + Dor fundoplication 12 years ago presents w/ worsening dysphagia x 1 year. Evaluations:
🔦Upper endoscopy - normal esophagus & intact wrap
⏳Timed barium - 10 cm column at 5 min
👇EndoFLIP & manometry as shown
#TracingTuesday
70 yo man w/ achalasia status post Heller myotomy + Dor fundoplication 12 years ago presents w/ worsening dysphagia x 1 year. Evaluations:
🔦Upper endoscopy - normal esophagus & intact wrap
⏳Timed barium - 10 cm column at 5 min
👇EndoFLIP & manometry as shown
#TracingTuesday (3/3)
Esophageal manometry showed a 2.5 cm hiatal hernia, normal IRP & no peristaltic abnormalities per Chicago classification. In 4/10 swallows & MRS response, there were multi-peak contractions, although w/ normal DCI & DL. Bolus transit/clearance were normal.
#TracingTuesday (2/4)
Contractile response on FLIP may sometimes become absent at higher volumes (60-70 mL) due to variations in length-tension relationship of circular muscles ➡️ this is a normal variant.
Overall, this study is “abnormal, but inconclusive”
Next ➡️ Manometry
From last #TracingTuesday (1/4)
FLIP analysis in pt w/ dysphagia:
🌟Mildly decreased/borderline distensibility at 60 & 70 mL distention.
🌟Borderline abnormal contractile response: RAC at 40 mL but w/ rapid rate of 12-13 contractions/min & RRC at 50 mL ➡️ ? suggest spasm
#TracingTuesday
60 year-old man w/ dysphagia presented for upper endoscopy, which was normal w/ no stricture or mucosal abnormality. FLIP analysis was performed using the 16 cm device.
How would you interpret the FLIP findings?
(👉 last image representative of both 60 & 70 mL)
From last #TracingTuesday
An important feature of this tracing is the lack of a pressure inversion point (PIP) + the similar pressure patterns by respiration above & below LES. This indicates that the catheter remained above the diaphragm & a large hiatal hernia is present (1/3)
#TracingTuesday
71 year-old man w/ history of gastric lap band (2008) was referred for esophageal function testing for ⬆️ reflux & regurgitation. Last UGIS (2014) reportedly normal. The lap band was deflated in clinic prior to study.
How would you interpret the manometry? (1/2)
@AllonKahn @MTPapaD @LindaNguyenMD @JPandolfinoMD @SalihSamo @EsophagusDoc @JeffConklinMD @AfrinKamalMD @KristleLynchMD @ZubairMalik_MD @john_damianosMD @GiJournal No worries. We will have #TracingTuesday tomorrow as the warm-up act for the motility #GIJC on Wednesday 😉
@magnushallandMD @WalterChanMD @AlkeshZala1 @DrHarryThomas Hypercontractile esophagus?
#tracingtuesday
Pt’s barium swallow showed delayed emptying in distal esophagus, tapering at EGJ & intact fundoplication wrap. She underwent surgery w/ lysis of significant adhesions around the wrap/EGJ.
Repeat manometry post-surgery: ⬇️ IRP & IBP + normal peristalsis.
#TracingTuesday (2/2)
From last #TracingTuesday:
As many noted, there’s ⬆️ residual pressure (IRP) at EGJ & significant ⬆️ intrabolus pressure (IBP), caused by liquid bolus trapped b/t distal contractile front & tight EGJ. DCI was ⬆️ as it tries to push liquid bolus through outflow obstruction. (1/2)
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