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Logo of jneuromotThis ArticleAims and ScopeInstructions to AuthorsE-SubmissionJournal of Neurogastroenterology and Motility
J Neurogastroenterol Motil. 2010 January; 16(1): 94–95.
Published online 2010 January 31. doi:  10.5056/jnm.2010.16.1.94
PMCID: PMC2879826

Butterfly in the Esophagus: What Is Wrong?

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.

Figure 1
High resolution manometry findings with 30 mmHg isobaric contour in a same case before (A) and after (B) reinsertion of the manometry catheter. (A) Each wet swallow evoked a primary peristalsis ending with two closely fused high pressure zones to which ...


Financial support: None.

Conflicts of interest: None.


1. Kahrilas PJ, Ghosh SK, Pandolfino JE. Esophageal motility disorders in terms of pressure topography: the Chicago Classification. J Clin Gastroenterol. 2008;42:627–635. [PMC free article] [PubMed]
2. Spechler SJ, Castell DO. Classification of oesophageal motility abnormalities. Gut. 2001;49:145–151. [PMC free article] [PubMed]
3. Kim JY, Kim CY, Park SM, et al. Erroneously recorded esophageal retrograde peristalsis due to a manometric catheter inadvertently hooked in the esophagus. Korean J Neurogastroenterol Motil. 2003;9:59–61.

Articles from Journal of Neurogastroenterology and Motility are provided here courtesy of The Korean Society of Neurogastroenterology and Motility