Harry J Wong1,2, Mason Vierra3, Mason Hedberg4, Mikhail Attaar4,5, Bailey Su4,5, Kristine Kuchta4, Gene Chiao6, John G Linn4, Stephen P Haggerty4, Michael B Ujiki4. 1. Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave GCSI rmB665 Evanston, Evanston, IL, 60201, USA. Harry.Wong@uchospitals.edu. 2. Department of Surgery, University of Chicago Medicine, Chicago, IL, USA. Harry.Wong@uchospitals.edu. 3. University of Chicago Pritzker School of Medicine, Chicago, IL, USA. 4. Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave GCSI rmB665 Evanston, Evanston, IL, 60201, USA. 5. Department of Surgery, University of Chicago Medicine, Chicago, IL, USA. 6. Department of Gastroenterology, NorthShore University HealthSystem, Evanston, IL, USA.
Abstract
BACKGROUND: Esophageal dysmotility is a common finding in patients being evaluated for antireflux surgery, although its implication remains unclear. We aimed to evaluate outcomes of patients with esophageal dysmotility after fundoplication. METHODS: A retrospective review of a prospective quality-database was performed. All patients who underwent laparoscopic Nissen (NF) or Toupet (TF) fundoplication were included. Esophageal dysmotility was defined using the Chicago Classification v4.0 and conventional metrics, creating three sub-groups: ineffective esophageal motility (IEM), distal/diffuse esophageal spasm (DES), and hypercontractile esophagus (HE). Quality of life (QOL) outcomes were measured by the Reflux Severity Index (RSI), Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL), and Dysphagia Scores. RESULTS: Of 487 patients included, 99 (20.3%) had esophageal dysmotility (49 IEM, 40 DES, 10 HE). While a majority in the dysmotility group (81.8%) underwent TF, most patients in the normal group (76.5%) underwent NF (p < 0.001). On multivariable analysis controlling for sex, age, BMI, hiatal hernia, and surgery type, the normal group had higher Dysphagia Scores at 3 weeks (2.2 ± 0.9 vs. 1.7 ± 0.8, p < 0.001), but not at 6-month, 1-year, 2-year, or 5-year follow-up. There were no differences between normal and dysmotility groups in terms of RSI or GERD-HRQL scores at any time point. Patients with different sub-types of esophageal dysmotility had similar QOL outcomes at all time points. CONCLUSION: Patients with esophageal dysmotility had similar outcomes compared to those with normal motility after fundoplication, suggesting the tailored approach favoring partial fundoplication for patients with dysmotility as part of an appropriate treatment algorithm.
BACKGROUND: Esophageal dysmotility is a common finding in patients being evaluated for antireflux surgery, although its implication remains unclear. We aimed to evaluate outcomes of patients with esophageal dysmotility after fundoplication. METHODS: A retrospective review of a prospective quality-database was performed. All patients who underwent laparoscopic Nissen (NF) or Toupet (TF) fundoplication were included. Esophageal dysmotility was defined using the Chicago Classification v4.0 and conventional metrics, creating three sub-groups: ineffective esophageal motility (IEM), distal/diffuse esophageal spasm (DES), and hypercontractile esophagus (HE). Quality of life (QOL) outcomes were measured by the Reflux Severity Index (RSI), Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL), and Dysphagia Scores. RESULTS: Of 487 patients included, 99 (20.3%) had esophageal dysmotility (49 IEM, 40 DES, 10 HE). While a majority in the dysmotility group (81.8%) underwent TF, most patients in the normal group (76.5%) underwent NF (p < 0.001). On multivariable analysis controlling for sex, age, BMI, hiatal hernia, and surgery type, the normal group had higher Dysphagia Scores at 3 weeks (2.2 ± 0.9 vs. 1.7 ± 0.8, p < 0.001), but not at 6-month, 1-year, 2-year, or 5-year follow-up. There were no differences between normal and dysmotility groups in terms of RSI or GERD-HRQL scores at any time point. Patients with different sub-types of esophageal dysmotility had similar QOL outcomes at all time points. CONCLUSION: Patients with esophageal dysmotility had similar outcomes compared to those with normal motility after fundoplication, suggesting the tailored approach favoring partial fundoplication for patients with dysmotility as part of an appropriate treatment algorithm.
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: R J Lund; G J Wetcher; F Raiser; K Glaser; G Perdikis; M Gadenstätter; N Katada; C J Filipi; R A Hinder Journal: J Gastrointest Surg Date: 1997 Jul-Aug Impact factor: 3.452