High-Resolution Manometry With Solid Provocative Test in Patients With Mid-Thoracic and Epiphrenic Esophageal Diverticula.

Background: The number of studies exploring esophageal motility disorders using high-resolution manometry (HRM) in patients with esophageal diverticula (ED) is limited. The goal of this study was to describe motility disorders using HRM in patients with ED and assess the added value of provocative testing in these patients.

Methods: Patients with ED who underwent HRM between 2010 and 2022 were retrospectively included. HRM findings were compared based on single water swallows (SWS), and provocative testing with solid food swallows in the upright seated position, using both ManoView and Medical Measurement Systems software. We also calculated median pressure slopes during the compartmentalization phase.

Results: Sixteen of the 39 included patients had mid-ED and 23 had lower ED. Twenty (51.3%) patients had motility disorders based on SWS, including 7 (18%) with achalasia and 3 (7.7%) with esophagogastric junction obstruction. No significant differences in esophageal motility disorders were observed in relation to the location of the ED. Solid food swallows were performed in 29 (74%) patients leading to a change in the HRM diagnosis in 7 (24.1%), all of whom showed elevated IRP. Median pressure slopes during the compartmentalization phase (n = 30) were elevated in patients both with and without motility disorders.

Conclusions: Half of the patients with mid- or lower ED had motility disorders on HRM. Adding solid food swallows during HRM in patients with ED improves the manometric diagnosis. Results suggest abnormal distensibility in these patients, indicated by elevated pressure slope, regardless of the presence of associated motility disorders.