C0300 - Spur of the Moment Removal: A Rare Complication of Esophageal Manometry

Danielle Joiner, MD, Gregory S. Bills, MD, Ryan Beyer, MD
University of Kentucky, Lexington, KY

Introduction: Esophageal manometry is a safe procedure that analyzes the contraction pressure of the esophagus. The well-known risks are patient discomfort, nasal trauma, and retching. To our knowledge and search of present literature, there has not been a reported incident of esophageal manometry probe becoming lodged in the nasopharynx. Here, we present a case of manometry probe meeting resistance upon attempted extubation, ultimately requiring endoscopic removal.

Case Description/Methods: A 53-year-old female with a history of GERD and hiatal hernia presented for routine esophageal manometry as part of anti-reflux surgery workup. The manometry probe was inserted into the right naris and advanced without difficulty. The procedure was performed without complications. Upon extubation, the probe met resistance. Multiple providers attempted extubation, all unsuccessful. The patient experienced increasing discomfort, and efforts to extubate were immediately stopped. A small amount of blood was noted in the right nares, and intranasal lidocaine 2% gel was administered. Planned EGD was then performed with manometry probe in place. Blood was seen in the posterior oropharynx, and manometry probe was visualized passing through the nares and seen in the oropharynx. The gastroscope was then advanced into the stomach where the end of the probe was visible. Removal of the probe was unable to be performed even under sedation, and ultimately the probe had to be sacrificed. The end of the manometry probe was grasped using a snare and the distal end was removed through the mouth. Due to the large connectors, the proximal end of the manometry probe exiting through the naris was cut, and the distal end of the probe was pulled through the mouth without resistance. EGD procedure was then completed. The patient was subsequently evaluated by ENT for nasal obstruction and was found to have a septal deviation with a very large right posterior septal spur that was contacting the lateral nasal wall on nasal endoscopy. We suspect that the spur acted similarly to a one-way valve; allowing easy insertion of the probe and difficulty with removal given the positional anatomy of the spur.

Discussion: In conclusion, we report a novel adverse event from routine manometry procedure leading to traumatic removal and ultimately sacrificing the manometry probe due to a large posterior nasal spur.


Disclosures:


Danielle Joiner, MD, Gregory S. Bills, MD, Ryan Beyer, MD. C0300 - Spur of the Moment Removal: A Rare Complication of Esophageal Manometry, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.