Small Bowel Motility Testing: Manometry and Scintigraphy

Small Bowel Motility Testing: Manometry and Scintigraphy

Kimberly N. Harer, MD

William L. Hasler, MD

If a patient’s small bowel motility is in question after standard evaluation and imaging (plain films or barium studies), manometry and scintigraphy are the main tools to assess motor function in this gut region. Manometry does not provide information regarding transit time, but it does measure intraluminal pressure changes caused by occlusive contractions of the bowel wall, which are indirect measures of contractile activity. In contrast, scintigraphy allows for the noninvasive measurement of small bowel transit time, but contractile activity is not evaluated.


This section will focus mainly on stationary techniques of small bowel manometry. Prolonging a stationary fasting manometry study to 6 hours provides the same accuracy as ambulatory 24-hour studies in more than 90% of patients and also provides manometric information about the antrum. If a lengthier recording or nocturnal study is needed, ambulatory systems are available.


  • 1. To assess for causes of gastric or small bowel dysmotility such as neuropathy, myopathy, or obstruction not identified by endoscopy or radiographic imaging

  • 2. To assess unexplained nausea, vomiting, bloating, abdominal distention, or other symptoms suggestive of upper gastrointestinal (GI) dysmotility

  • 3. To distinguish generalized from localized gastrointestinal dysmotility in patients with dysmotility elsewhere (i.e., chronic constipation, gastroparesis, gastroesophageal reflux)

  • 4. To evaluate small bowel motility in patients with slow transit constipation undergoing consideration of total colectomy

  • 5. To diagnose suspected chronic intestinal pseudo-obstruction (CIP) when the diagnosis is unclear

  • 6. To provide information to help select the optimal approach to feeding CIP patients (oral, gastric, jejunal, total parenteral nutrition [TPN])

  • 7. To assess potential therapeutic response to a medical intervention or medication

  • 8. To help exclude small bowel motor dysfunction with an entirely normal study


  • 1. A 12-hour fast is required, with clear liquids for the evening meal on the day before testing. Some labs require up to 2 days of full liquid diet prior to testing.

  • 2. Cessation of medications affecting motility for at least 48 to 72 hours prior to testing (including narcotics, macrolides, metoclopramide, anticholinergics, adrenergics). For diabetic patients, many centers will postpone study performance unless the blood glucose is <200 to 275 mg/dL at the start of testing due to effects of hyperglycemia to alter normal small bowel contractility.

  • 3. If the patient is on TPN, discontinue the infusion 8 hours before the study.

  • 4. If sedation for catheter placement is necessary, propofol or a short-acting benzodiazepine followed by a waiting period of at least an hour is recommended prior to proceeding with measurements in order to avoid possible drug-induced motility effects.

May 29, 2020 | Posted by in GASTROENTEROLOGY | Comments Off on Small Bowel Motility Testing: Manometry and Scintigraphy

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