2005 Abstracts: The Potential Role of Impedance in the Evaluation of Post: Fundoplication Dysphagia
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The Potential Role of Impedance in the Evaluation of Post: Fundoplication Dysphagia
Taner Yigit, Elina Quiroga, Brant K. Oelschlager, University of Washington, Seattle, WA
Dysphagia after fundoplication may be from anatomic abnormalities (hernia or imperfections of the fundoplication) and/or from impaired esophageal motility. Manometry has poor sensitivity for detecting such motility impairments. Multichannel impedance, by measuring esophageal clearance, may be a more sensitive measure of esophageal motility.
Methods: Between 4/02 and 11/04, 85 patients were evaluated after laparoscopic antireflux surgery with impedance and manometry. Fifty-two patients had dysphagia, and the others had recurrent reflux or were undergoing routine post-operative follow-up. Results: Of those with dysphagia (n=52), 9 (17%) had abnormal manometry, 29 (56%) abnormal anatomy, and 32 (62%) abnormal impedance.
Patients with dysphagia had less effective esophageal clearance (49%) than those without dysphagia (67%, p=0.01). When patients with abnormal anatomy are excluded, those with dysphagia still had significantly impaired esophageal clearance (53%) compared with those without dysphagia (74%, p=0.04). There was no significant difference in manometry between those patients with and without post-op dysphagia (p=0.35). In addition, there was not a statistically significant difference in esophageal clearance between those with (49%) and without (63%) abnormal anatomy (p=0.08). Conclusions: Many patients after fundoplication have dysphagia and impaired esophageal clearance that can not be explained by manometry or abnormal anatomy, but only by impedance. The addition of esophageal impedance provides objective evidence of impaired esophageal motility in patients with post fundoplication dysphagia.
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