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A 55-year old man was referred for an esophageal manometry after cardiologic evaluation due to chest pain. High resolution manometry was performed with ManoScan 360™ High-Resolution Manometry System (Sierra Scientific Instruments, Los Angeles, CA, USA) using a catheter with 36 pressure channels and the finding looked like flying butterflies with their wings fully spread (Fig. 1A). Considering a possibility of a U-shaped bending of the catheter in the esophagus, the catheter was removed and re-inserted and then the butterflies disappeared (Fig. 1B). The manometric diagnosis of this case was mild peristaltic dysfunction according to the Chicago classification of esophageal motility1 and ineffective esophageal motility according to the conventional criteria.2 In conclusion, although not frequently experienced, a high resolution manometry catheter can also be hooked in the esophagus like a conventional manometry catheter3 and care should be taken not to push a catheter with an excess force if resistance is felt during insertion.
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