Clinical utility of pharyngeal high‐resolution manometry with impedance for upper esophageal sphincter dysfunction in gastroenterology

Pharyngeal high‐resolution manometry with impedance (P‐HRM‐I) is an established assessment method used to evaluate pharyngeal swallowing. It provides precise quantification of swallowing biomechanics that enable the detection of alterations in swallowing physiology. By identifying and localizing the mechanical breakdown during swallowing, P‐HRM‐I can be used to meaningfully guide clinical decision making and can assist in evaluating treatment techniques by demonstrating an intervention's true effect on the pharyngeal swallowing mechanics. Although P‐HRM‐I uptake in the research field has grown exponentially, its application in the clinical setting remains protracted. The expertise of Gastroenterology in esophageal HRM provides the basis for a foreseeable extension to P‐HRM‐I, which is emerging in some international centers. This review article describes the standardized P‐HRM‐I assessment procedure and analysis principles relevant to pharyngeal dysphagia conditions often seen in Gastroenterology practice. Analysis and interpretation using the cloud‐based platform, Swallow Gateway ( www.swallowgateway.com ), are detailed using outcome measures agreed upon by international expert consensus. Descriptions of three illustrative case examples of upper esophageal sphincter (UES) dysfunction are outlined, including longitudinally in a patient diagnosed with motor neurone disease, and two cases pre‐and post‐procedural interventions; one involving a dilatation and the other a cricopharyngeal‐peroral endoscopic myotomy.