Society for Surgery of the Alimentary Tract

2005 Abstracts: Impedance Improves Understanding of Esophageal Motility Before Antireflux Surgery

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Impedance Improves Understanding of Esophageal Motility Before Antireflux Surgery
Elina Quiroga, Brant K. Oelschlager, The Swallowing Center - University of Washington, Seattle, WA

Manometry has traditionally been used to assess esophageal motility before antireflux surgery but has limitations. We tested the hypothesis that esophageal multichannel intraluminal impedance (MII) which directly measures bolus transit through the esophagus would provide more accurate information than manometry in the preoperative evaluation of patients with reflux.

Method: We performed simultaneous MII and manometry as well as pH monitoring in 106 consecutive patients without obstruction of the cardia (i.e. no stricture, paraesophageal hernia, or prior antireflux procedure) being evaluated for antireflux surgery. Twelve patients have undergone laparoscopic antireflux surgery and postoperative MII/manometry (median f/u time = 9 mo, 6-22 mo). Results: All patients had abnormal preop pH monitoring (mean De Meester score 51, 14-229). MII and manometry were normal in 61 patients (58 %); and both were abnormal in 16 (15 %). MII was abnormal and manometry was normal in 29 (27 %), but no patient had abnormal manometry and normal MII. Twenty-two patients (26 %) presented with dysphagia.

	DeMeester Score	Complete bolus transit (MII)*	Bolus transit time (MII)**	Abnormal manometry�
No Dysphagia (n=84)	51	68%	6.9 sec	11 patients
Dysphagia (n=22)	53	63%	7.1 sec	5 patients
P - Value	0.79	0.51	0.59	0.25

% of swallows that completely exit the esophagus ** Time from bolus entering into and exiting the esophagus �Abnormal manometry: 30 % or more swallows with distal esophageal amplitude < 30 mmHg. MII and Manometry before and after Nissen Fundoplication

	Complete bolus transit (MII)*	Bolus transit time (MII)**	Peristalsis	Distal esophageal amplitude
Before Nissen	82.50%	9.0 sec	94.60%	74 mmHg
After Nissen	63.30%	10.1sec	95.20%	80 mmHg
P value	0.06	0.06	0.89	0.62

The only patient with post-operative dysphagia, was 1 of 2 with abnormal pre-op MII. Conclusions: Dysphagia in patients with GERD before operation is not associated with impaired esophageal clearance. Many more patients with severe GERD have abnormalities in impedance than manometry. A laparoscopic Nissen fundoplication impairs esophageal clearance, but does not usually create dysphagia. MII provides more accurate information than manometry with regards to esophageal clearance.

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