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 |
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 |