J M Hui1, D R Hunt, D J de Carle, R Williams, I J Cook. 1. Departments of Gastroenterology, and Upper GI Surgery, The St. George Hospital, University of New South Wales, Sydney, Australia.
Abstract
OBJECTIVE: Persistent dysphagia occurs in 5-10% of patients after fundoplication. The cause is obscure in most cases, and the management has not been well established. The aim of this study is to evaluate the clinical outcomes and the predictors of success for esophageal pneumatic dilations in patients with dysphagia after fundoplication. METHODS: We retrospectively reviewed 14 patients who underwent pneumatic dilation for persistent postfundoplication dysphagia. All patients had esophageal manometry before dilations. RESULTS: There were nine responders to pneumatic dilations (30-40-mm balloons). The nadir lower esophageal sphincter (LES) relaxation pressure was the only significant predictor for successful dilation and was higher among the responders than nonresponders (median 10 mm Hg vs 5 mm Hg). All six of 14 patients with nadir LES pressure > or = 10 mm Hg had a good response. There was no significant difference in the LES basal pressure between the responders and nonresponders (median 20 mm Hg vs 12 mm Hg). The median distal peristaltic amplitude (74 mm Hg vs 69 mm Hg), percent of failed peristalsis (8% vs 45%), and ramp pressure (19 mm Hg vs 17 mm Hg) did not differ significantly between the responders and nonresponders. No perforations occurred. CONCLUSIONS: Pneumatic dilation is a reasonably safe and effective treatment for patients with postfundoplication dysphagia. Raised nadir LES relaxation pressure seems to be a useful predictor of successful outcome.
OBJECTIVE: Persistent dysphagia occurs in 5-10% of patients after fundoplication. The cause is obscure in most cases, and the management has not been well established. The aim of this study is to evaluate the clinical outcomes and the predictors of success for esophageal pneumatic dilations in patients with dysphagia after fundoplication. METHODS: We retrospectively reviewed 14 patients who underwent pneumatic dilation for persistent postfundoplication dysphagia. All patients had esophageal manometry before dilations. RESULTS: There were nine responders to pneumatic dilations (30-40-mm balloons). The nadir lower esophageal sphincter (LES) relaxation pressure was the only significant predictor for successful dilation and was higher among the responders than nonresponders (median 10 mm Hg vs 5 mm Hg). All six of 14 patients with nadir LES pressure > or = 10 mm Hg had a good response. There was no significant difference in the LES basal pressure between the responders and nonresponders (median 20 mm Hg vs 12 mm Hg). The median distal peristaltic amplitude (74 mm Hg vs 69 mm Hg), percent of failed peristalsis (8% vs 45%), and ramp pressure (19 mm Hg vs 17 mm Hg) did not differ significantly between the responders and nonresponders. No perforations occurred. CONCLUSIONS: Pneumatic dilation is a reasonably safe and effective treatment for patients with postfundoplication dysphagia. Raised nadir LES relaxation pressure seems to be a useful predictor of successful outcome.
Authors: Katrin Schwameis; Jörg Zehetner; Kais Rona; Peter Crookes; Nikolai Bildzukewicz; Daniel S Oh; Geoffrey Ro; Katherine Ross; Kulmeet Sandhu; Namir Katkhouda; Jeffrey A Hagen; John C Lipham Journal: J Gastrointest Surg Date: 2016-11-10 Impact factor: 3.452
Authors: Konstantinos I Makris; Maria A Cassera; Andrew S Kastenmeier; Christy M Dunst; Lee L Swanström Journal: Surg Endosc Date: 2011-09-10 Impact factor: 4.584
Authors: Sarmed S Sami; Hasan N Haboubi; Yeng Ang; Philip Boger; Pradeep Bhandari; John de Caestecker; Helen Griffiths; Rehan Haidry; Hans-Ulrich Laasch; Praful Patel; Stuart Paterson; Krish Ragunath; Peter Watson; Peter D Siersema; Stephen E Attwood Journal: Gut Date: 2018-02-24 Impact factor: 23.059