Background Biliary manometry requires measurement and analysis of sphincter of Oddi pressures at several stations during a pull-through technique. Smooth muscle relaxants routinely employed during papillary cannulation at ERCP cannot be used because of their relaxant effect on the sphincter. Consequently, marked duodenal motility is often present. This and patient movement can displace the manometry catheter from the intended recording station. Duodenal contractions may also alter the baseline against which biliary manometric readings are taken. Such events can limit the quality of the trace and its subsequent analysis, potentially influencing the interpretation of sphincter pressure values and sphincter pressure wave frequency and propagation. Although possible to annotate the trace during recording using most software, this is laborious and impossible to perform rapidly enough to describe all the events during the period of recording. Aim To improve the quality and reliability of biliary manometry using endoscopic images obtained at the procedure. Endoscopic image video capture The Sedia software for manometry recording allows for synchronised high quality video image capture of the endoscopic view, displayed on the same monitor as that showing the manometry tracing. This allows the manometry operator to visualise more easily duodenal contractions and catheter position, facilitating an immediate assessment of the quality and validity of the trace before advising the endoscopist to proceed to the next station. At subsequent analysis, the endoscopic view remains available, synchronised with the manometry recording. Scrolling through the manometry trace shows the endoscopic image at any given time point. Alternatively, the video loop can be played with simultaneous synchronised display of a marker progressing along the manometry trace. Thus duodenal activity and catheter position at the time of relevant manometric events can be viewed. Conclusion We believe this facility enhances the quality of the manometry tracing and the reliability of analysis, particularly if this is performed some time afterwards or by an analyst not present at the original recording. The full extent to which this equipment improves the conclusions from biliary manometry studies requires formal assessment, which is in progress. It is also a useful teaching addition when demonstrating the procedure. Background Biliary manometry requires measurement and analysis of sphincter of Oddi pressures at several stations during a pull-through technique. Smooth muscle relaxants routinely employed during papillary cannulation at ERCP cannot be used because of their relaxant effect on the sphincter. Consequently, marked duodenal motility is often present. This and patient movement can displace the manometry catheter from the intended recording station. Duodenal contractions may also alter the baseline against which biliary manometric readings are taken. Such events can limit the quality of the trace and its subsequent analysis, potentially influencing the interpretation of sphincter pressure values and sphincter pressure wave frequency and propagation. Although possible to annotate the trace during recording using most software, this is laborious and impossible to perform rapidly enough to describe all the events during the period of recording. Aim To improve the quality and reliability of biliary manometry using endoscopic images obtained at the procedure. Endoscopic image video capture The Sedia software for manometry recording allows for synchronised high quality video image capture of the endoscopic view, displayed on the same monitor as that showing the manometry tracing. This allows the manometry operator to visualise more easily duodenal contractions and catheter position, facilitating an immediate assessment of the quality and validity of the trace before advising the endoscopist to proceed to the next station. At subsequent analysis, the endoscopic view remains available, synchronised with the manometry recording. Scrolling through the manometry trace shows the endoscopic image at any given time point. Alternatively, the video loop can be played with simultaneous synchronised display of a marker progressing along the manometry trace. Thus duodenal activity and catheter position at the time of relevant manometric events can be viewed. Conclusion We believe this facility enhances the quality of the manometry tracing and the reliability of analysis, particularly if this is performed some time afterwards or by an analyst not present at the original recording. The full extent to which this equipment improves the conclusions from biliary manometry studies requires formal assessment, which is in progress. It is also a useful teaching addition when demonstrating the procedure.