Maggie M Hodges1, Melissa L DeSouza2,3, Kevin M Reavis2,3, Daniel Davila Bradley2,3, Christy M Dunst2,3. 1. Providence Portland Medical Center, 4805 NE Glisan Street, Suite 6N60, Portland, OR, 97213, USA. mmhodges@gmail.com. 2. Providence Portland Medical Center, 4805 NE Glisan Street, Suite 6N60, Portland, OR, 97213, USA. 3. Center for Advanced Surgery, The Oregon Clinic, Portland, OR, 97213, USA.
Abstract
INTRODUCTION: The aim was to evaluate the clinical significance of multiple rapid swallows (MRS) during high-resolution manometry (HRM) prior to fundoplication. Despite pre-operative HRM, up to 38% of patients report post-fundoplication dysphagia. Suggestion that MRS improves prediction of dysphagia after fundoplication has not been investigated when using a tailored approach. We hypothesize response to MRS is predictive of dysphagia after tailored fundoplication. METHODS: A retrospective cohort study was performed on patients undergoing HRM with MRS provocation 5/2019-7/2021 at a single institution. Patients who underwent subsequent index laparoscopic fundoplication, without peptic stricture or achalasia, were included. After performing standard 10-swallow HRM, MRS provocation was performed. Patient-reported dysphagia frequency scores were collected at initial consultation and post-operative follow-up. At least weekly symptoms were considered clinically significant. Normal MRS response was defined as adequate deglutitive inhibition and MRS contractile response. Fundoplications were tailored based on standard HRM values. RESULTS: HRM was performed in 1201 patients, 220 met inclusion criteria. Clinically significant pre-operative dysphagia was reported by 85 (38.6%). Patients undergoing partial fundoplication (n = 123, 55.9%) had lower mean distal contractile integer, distal esophageal contraction amplitude, and percent peristalsis (p < 0.005). Post-operatively, 120 (54.5%) were without dysphagia, 59 (26.8%) had improved dysphagia, 26 (11.8%) had unchanged dysphagia, and 15 (6.8%) reported new dysphagia. There was no statistical difference in early or late dysphagia outcome between tailored fundoplication groups (p = 0.69). On univariate and multivariate analysis, neither MRS response, nor standard HRM metrics were significantly associated with post-operative dysphagia. Younger age (OR 0.96, 95% CI 0.94-0.986, p = 0.042) and the presence of pre-operative dysphagia (OR 2.54, 95% CI 1.17-5.65, p = 0.015) were significant predictors of post-operative dysphagia. CONCLUSION: The risk of clinically significant dysphagia post-fundoplication is low when using a tailored approach based on standard HRM metrics. Additional data provided by MRS does not add to surgical decision-making using the investigated approach.
INTRODUCTION: The aim was to evaluate the clinical significance of multiple rapid swallows (MRS) during high-resolution manometry (HRM) prior to fundoplication. Despite pre-operative HRM, up to 38% of patients report post-fundoplication dysphagia. Suggestion that MRS improves prediction of dysphagia after fundoplication has not been investigated when using a tailored approach. We hypothesize response to MRS is predictive of dysphagia after tailored fundoplication. METHODS: A retrospective cohort study was performed on patients undergoing HRM with MRS provocation 5/2019-7/2021 at a single institution. Patients who underwent subsequent index laparoscopic fundoplication, without peptic stricture or achalasia, were included. After performing standard 10-swallow HRM, MRS provocation was performed. Patient-reported dysphagia frequency scores were collected at initial consultation and post-operative follow-up. At least weekly symptoms were considered clinically significant. Normal MRS response was defined as adequate deglutitive inhibition and MRS contractile response. Fundoplications were tailored based on standard HRM values. RESULTS: HRM was performed in 1201 patients, 220 met inclusion criteria. Clinically significant pre-operative dysphagia was reported by 85 (38.6%). Patients undergoing partial fundoplication (n = 123, 55.9%) had lower mean distal contractile integer, distal esophageal contraction amplitude, and percent peristalsis (p < 0.005). Post-operatively, 120 (54.5%) were without dysphagia, 59 (26.8%) had improved dysphagia, 26 (11.8%) had unchanged dysphagia, and 15 (6.8%) reported new dysphagia. There was no statistical difference in early or late dysphagia outcome between tailored fundoplication groups (p = 0.69). On univariate and multivariate analysis, neither MRS response, nor standard HRM metrics were significantly associated with post-operative dysphagia. Younger age (OR 0.96, 95% CI 0.94-0.986, p = 0.042) and the presence of pre-operative dysphagia (OR 2.54, 95% CI 1.17-5.65, p = 0.015) were significant predictors of post-operative dysphagia. CONCLUSION: The risk of clinically significant dysphagia post-fundoplication is low when using a tailored approach based on standard HRM metrics. Additional data provided by MRS does not add to surgical decision-making using the investigated approach.
Authors: Dustin A Carlson; Alexandra J Baumann; Erica N Donnan; Amanda Krause; Wenjun Kou; John E Pandolfino Journal: Neurogastroenterol Motil Date: 2021-03-11 Impact factor: 3.960
Authors: Nikolaos Machairas; Dimitri A Raptis; Patricia Sánchez Velázquez; Alain Sauvanet; Alexandra Rueda de Leon; Atsushi Oba; Bas Groot Koerkamp; Brendan Lovasik; Carlos Chan; Charles J Yeo; Claudio Bassi; Cristina R Ferrone; David Kooby; David Moskal; Domenico Tamburrino; Dong-Sup Yoon; Eduardo Barroso; Eduardo de Santibañes; Emanuele F Kauffmann; Emanuel Vigia; Fabien Robin; Fabio Casciani; Fernando Burdío; Giulio Belfiori; Giuseppe Malleo; Harish Lavu; Hermien Hartog; Ho-Kyoung Hwang; Ho-Seong Han; Hugo P Marques; Ignasi Poves; Ismael Domínguez-Rosado; Joon-Seong Park; Keith D Lillemoe; Keith Roberts; Laurent Sulpice; Marc G Besselink; Mahmoud Abuawwad; Marco Del Chiaro; Martin de Santibañes; Massimo Falconi; Mizelle D'Silva; Michael Silva; Mohammed Abu Hilal; Motaz Qadan; Naomi M Sell; Nassiba Beghdadi; Niccolò Napoli; Olivier R C Busch; Oscar Mazza; Paolo Muiesan; Philip C Müller; Reena Ravikumar; Richard Schulick; Sarah Powell-Brett; Syed Hussain Abbas; Tara M Mackay; Thomas F Stoop; Tom K Gallagher; Ugo Boggi; Casper van Eijck; Pierre-Alain Clavien; Kevin C P Conlon; Giuseppe Kito Fusai Journal: Ann Surg Date: 2021-11-01 Impact factor: 12.969