UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE
TITLE: ESOPHAGEAL MANOMETRY
SCHEDULING and PATIENT INSTRUCTION
Effective Date: October, 2005 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education
Reviewed May, 2008 May 2010 September 2012
PURPOSE: To provide guidelines for scheduling an Esophageal Manometry at UWMF Clinics.
DEFINITION: Esophageal Manometry is a diagnostic test that measures the pressures of the esophagus. It is used to
diagnose Reflux Disease, and is generally completed on those patients complaining of chronic cough, upper chest pain, or
POLICY: The clinical staff will utilize the following guidelines to schedule a Manometry.
1. Check provider’s order and clarify any inconsistencies.
Tests can be scheduled 2 per day; and should be scheduled at least 2 hours apart
Current procedure is done by Dr. Magenheim and Dr. Williams
Patients are to be scheduled on Mondays and Wednesdays at 8:00am with a 7:00am arrival
Appointment will be taken on first-come/first served basis
2. Contact the patient and identify them by confirming full name and date of birth.
3. Explain procedure and instruct the patient to:
Have nothing by mouth after midnight for a morning procedure.
o Can have a clear liquid breakfast for an afternoon procedure.
Arrive at Meriter Registration 1-hour before the scheduled appointment time.
That they may drive home safely alone (will not be sedated for the procedure)
4. Schedule follow-up appointment following the procedure (if indicated by provider).
WRITTEN BY: Ronnie Peterson, R.N., M.S., Manager of Clinical Support
REVIEWED BY: Laurie Woodhouse, Manager, UWMF Gastroenterology
REVISED BY: Carol Decker, RN, MSN, Clinical Staff Educator
Division of Gastroenterology & Hepatology Date
Medical Director Date