Technical Services for Motility Disorders

The Suzi and Scott Lustgarten Center for GI Motility offers technical services for patients with GI and motility disorders.

High-resolution esophageal manometry

This study helps determine the strength of the muscles and the pressure in the lower part of a patient’s esophagus. It is useful in evaluating swallowing abnormalities. A thin, flexible tube is inserted into the patient’s nose and into the stomach, then slowly pulled back into the esophagus to ensure proper placement. Patients will be asked to swallow and the pressure of the muscle contractions in the esophagus will be measured.

EsoFLIP and EndoFLIP measurement and dilatation

EndoFLIP® is an advanced balloon dilation technology used during endoscopy. It transforms patient treatment of esophageal strictures without the need for fluoroscopy, which is particularly preferable for pediatric patients. EndoFLIP interfaces with the EndoFLIP system to provide a comprehensive view of the esophagus to accurately measure stricture size before and after each stage of balloon dilation. These procedures are cutting-edge and require extensive training and specialized equipment. Children’s Hospital of Philadelphia (CHOP) is one of the few hospitals nationally that offer EsoFLIP® and EndoFLIP. As a result, nearly all achalasia cases in the tristate area are referred to the Suzi and Scott Lustgarten Center for GI Motility.

Technical and endoscopic therapy of motility disorders

We are using EndoFLIP and EsoFLIP to assess esophageal body and lower esophageal sphincter compliance in patients with eosinophilic esophagitis and achalasia respectively. We have presented at international and local meetings with data that we have obtained. Novel technologies that we offer include auricular neurostimulation for patients with chronic pain and nausea. We continue to offer pH impedance, and developed a collaboration with Airway colleagues as these studies help direct surgical interventions.

Endoscopic therapies for motility disorders, POEM, EUS

Peroral endoscopic myotomy (POEM) is the most advanced endoscopic treatment for the treatment of achalasia. Through our partnership with the Hospital at the University of Pennsylvania (HUP), we’re able to offer this rare and highly effective procedure. Endoscopic ultrasound (EUS) is a procedure performed by our colleagues at HUP that allows for high-resolution imaging of the esophageal wall. It evaluates esophageal wall thickening that allows for EUS-directed treatments of the esophageal wall and lower esophageal sphincter.

Balloon dilatation of strictures and obstructions

We offer treatment options that are less invasive than surgery, including dilation of the lower esophagus. This procedure is performed during gastrointestinal endoscopy. It is considered in children or teens with achalasia or for those who continue to have symptoms despite corrective surgery.

pH impedance and bravo pH measurement

Doctors often perform pH monitoring and impedance testing along with gastrointestinal endoscopy. During this test, the doctor inserts a small wire into the lower part of the esophagus. The wire carries a device that measures the amount of reflux (acid or nonacid) going into the area

Botulinum toxin (Botox) injection of sphincters

This treatment involves injecting Botox® into the pyloric sphincter, which is the muscle inside the body at the end of the stomach through which food passes to the small intestine. This procedure is done during gastrointestinal endoscopy for some children or teens with gastroparesis. Botox can also be used for refractive constipation to help relax the internal anal sphincter.

AntroDuodenal motility studies

An antroduodenal manometry study sometimes provides information about the muscle and nerve activity of the stomach and small bowel. The test can measure how strong and how well a child’s muscle contractions coordinate between the two organs. To perform the test, a small flexible tube is inserted into the patient’s nose, down the esophagus, through the stomach and into the small intestine. 

Colonic manometry

This procedure tests the function of the large bowel (large colon). A specialized catheter with sensors is placed under anesthesia into the colon. During the test, information about the strength and coordination of the muscle contractions in the colon are measured.  Readings are done at rest, in response to a standard meal, and in response to a stimulant medication.

Sitz markers

This study is used to assess colonic transit. Your child will be given a capsule with 24 radiopaque rings that will be swallowed. Timed X-ray will be completed and will show how the markers are moving through the bowel and give us information on colon transit time.

Anorectal manometry

This procedure tests the strength of the muscles in the rectum and anus. These muscles normally tighten to hold in a bowel movement and relax when a bowel movement is passed. Anorectal manometry is helpful in evaluating constipation and other anal and rectal issues. This technique uses a balloon inserted into a child’s rectum to measure how well their anus and rectum contract to release or hold bowels. 

Biofeedback (electromyography and rectal biofeedback)

This therapy may help in a range of conditions. As biofeedback is noninvasive and does not involve drugs, there is a low risk of undesirable side effects. 

Electromyography and biofeedback therapy measure muscle tension. During the sessions, the therapist attaches electrodes to the patient's skin and outside of the rectum. These sensors are connected to a computer and information related to defecation dynamics (the way the muscles are coordinated) can be seen on a monitoring screen. The therapist views the measurements on the monitor and identifies the coordination of abdominal muscle function and rectal sphincter relaxation to help with defecation. 

Surgery of gastrointestinal motility disorders

The Suzi and Scott Lusgarten Center for GI Motility works with surgeons who are highly effective operating on patients with achalasia. Our surgeons perform:

  • Peroral endoscopic myotomy (POEM)
  • Heller
  • Feeding tubes insertion: gastrostomy, jejunostomy, gastrojejunal pyeloplasty
  • Pyloromyotomy to treat pyloric stenosis
  • Tracheoesophageal fistula repair
  • VACTERL (vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities)
  • Colorectal repairs

Vagal nerve stimulation for abdominal pain (neurostimulation)

This novel therapy involves the use of a device to stimulate the vagus nerve with electrical impulses. New, noninvasive vagus nerve stimulation devices have been approved in Europe for pain. In recent studies, vagal nerve stimulation has had positive outcomes in children with chronic, intractable abdominal pain.

Breath testing: carbohydrate and H pylori

Breath tests are used to evaluate for small bowel bacterial overgrowth, lactose intolerance, fructose intolerance and methane productions. We offer several hydrogen breath tests at CHOP. In addition, urea breath test (UBT), is the most accurate and best validated of the currently available breath tests. The UBT is an accurate noninvasive method of identifying active Helicobacter pylori (H pylori) infection before and after antibiotic therapy.