Effects of Posture and Swallow Volume on Esophageal Motility Morphology and Probability of Bolus Clearance: A Study Using High-Resolution Impedance Manometry.

The Chicago classification diagnostic criteria of esophageal motility disorders are based on 5-ml water swallows in the supine position and have not been analyzed for the correlation between the morphology and bolus transit in the upright position and larger volume swallow conditions. This study aimed to evaluate the effect of posture and swallow volume on peristaltic morphology and the probability of bolus clearance in patients with nonspecific esophageal disorder. A total of 139 patients (4,214 swallows) were included for high-resolution impedance manometry analysis in the right lateral recumbent and upright positions, as well as 5- and 10-ml liquid swallows. Intact peristalses were more frequent in the right lateral recumbent position than in the upright position. No difference was reported on failed peristalsis between both positions. Breaks were more frequent in the upright position. A 20 mmHg isobaric contour (compared with 30 mmHg) was associated with decreased bolus clearance. Bolus clearance probability with 10-ml swallows is greater than that with 5-ml swallows. There was no significant difference in the total bolus clearance comparing between the right lateral recumbent and upright positions. The right lateral recumbent position was associated with a higher intact peristalsis. The volume of swallow did not affect the integrality of esophageal peristalsis but did improve the bolus clearance.

Impact of Endotracheal Intubation on Interventional Endoscopy Unit Efficiency Metrics at a Tertiary Academic Medical Center.

OBJECTIVES: Measures for evaluating interventional endoscopy unit efficiency have not been adequately validated, especially in reference to the involvement of anesthesia services for endoscopy. Primary aim was to compare process measures/metrics of interventional endoscopy unit efficiency between intubated and non-intubated patients. Secondary aim was to assess variables associated with the need for endotracheal intubation. METHODS: The prospectively collected endoscopy unit metrics database at UF Health was reviewed for procedures performed in the interventional endoscopy unit for 6 months. Parameters included hospital-mandated metrics available from the database. RESULTS: A total of 1,421 patients underwent 1,635 interventional endoscopic procedures and 271/1,421 patients (19.1%) were intubated. There was no significant difference between intubated and non-intubated cohorts with respect to age, gender, BMI, ASA Score, Mallampati Score, or the Charlson Comorbidity Index. Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) were more frequently intubated than those undergoing non-ERCP procedures (41.3 vs. 12.4%, P<0.0001). Inpatients comprised 48.3% of all intubated patients, whereas only 29.2% of non-intubated patients were inpatients (P<0.0001). Most patients (159/271, 58.7%) were intubated per anesthesiologist preference. All process efficiency metrics were significantly prolonged in the intubated compared with the non-intubated patient cohort, except the time interval between successive procedures. Multivariate analysis revealed that patients with an anesthesiologist who had performed a greater number of total endoscopic sedations were less likely to be intubated than patients with an anesthesiologist who had performed fewer total procedures (P=0.0066). CONCLUSIONS: Endotracheal intubation negatively impacts efficiency metrics in an interventional endoscopy unit. Careful assessment for the need for intubation should be emphasized.