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Original article
Learners favour high resolution oesophageal manometry with better diagnostic accuracy over conventional line tracings
  1. A Samad Soudagar,
  2. Gregory S Sayuk,
  3. C Prakash Gyawali
  1. Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
  1. Correspondence to C Prakash Gyawali, Professor of Medicine, Division of Gastroenterology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8124, St Louis, MO 63110, USA; cprakash{at}


Background High resolution manometry (HRM) provides a colourful representation of oesophageal motility. Novice and intermediate learners were tested to compare HRM Clouse plots and conventional manometry for accuracy, ease of interpretation and knowledge retention.

Methods 36 learners evaluated 60 randomised motility sequences (30 HRM Clouse plots with corresponding line tracings) 4 months apart, following a tutorial. Learners rated prior knowledge of oesophageal pathophysiology and manometry and scored ease and speed of interpretation on 10 cm visual analogue scales (VAS).

Results Understanding of oesophageal pathophysiology was low in all cohorts (2.9±0.4 on VAS) and knowledge of HRM and conventional motility studies was even lower (1.9±0.4 and 1.8±0.3, respectively, p=NS). After the tutorial, diagnostic accuracy was significantly higher with HRM Clouse plots than with line tracings (p<0.001). HRM gains in diagnostic accuracy were evident over line tracings (43.1%), particularly with aperistalsis (36.1%), oesophageal body hypomotility (25.8%) and relaxation of the lower oesophageal sphincter (21.0%) (p<0.001 for each comparison); these were maintained at the second evaluation. Gains were independent of academic level (F=0.56, p=0.5) and did not correlate with prior experience of learners (r=−0.18, p=0.29). Learners favoured HRM Clouse plots (80.6%) over line tracings and reported faster interpretation (94.4%).

Conclusions HRM Clouse plots provide ease of interpretation that translates into higher diagnostic accuracy and better knowledge retention in novice and intermediate learners of oesophageal manometry. These results implicate the value of pattern recognition in HRM interpretation, irrespective of academic level and prior understanding of oesophageal motor function.

  • High resolution manometry
  • oesophagus
  • interpretation
  • achalasia
  • ambulatory PH monitoring
  • oesophageal motility
  • anti-reflux therapy
  • motility disorders

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  • Presented in preliminary form at the Annual Meeting of the American Gastroenterological Association, Chicago, May 2011.

  • Funding This study was partially funded through Washington University Mentors in Medicine (MiM) award and by NIH K23DK84413-2 (GSS).

  • Competing interests None.

  • Ethics approval Human Research Protection Office at Washington University School of Medicine, St Louis.

  • Provenance and peer review Not commissioned; externally peer reviewed.