IMPACT OF DELAYED GASTRIC EMPTYING ON THE OUTCOME OF MAGNETIC SPHINCTER AUGMENTATION
Shahin Ayazi*, Katrin Schwameis, Ping Zheng, Ali H. Zaidi, Kristy L. Chovanec, Madison Salvitti, Xinxin Shen, Andrew Grubic, Kirsten Newhams, Toshitaka Hoppo, Blair Jobe
Esophageal Institute, Allegheny Health Network, Pittsburgh, PA
Introduction:
Delayed gastric emptying has been postulated as a contributing factor in the pathophysiology of gastroesophageal reflux disease (GERD). Magnetic sphincter augmentation (MSA) is increasingly utilized in the primary management of GERD. The impact of delayed gastric emptying (DGE) on the outcome of MSA is unknown. We designed the current study to evaluate the effect of delayed gastric emptying on the subjective and objective outcome of MSA.
Material and methods:
A total of 636 patients underwent MSA at our institution in a 6-year period. Patients who presented with symptoms suggestive for delayed gastric emptying (nausea, vomiting, bloating, early or prolonged satiety) underwent gastric emptying (GE) study in addition to routine preoperative foregut evaluation. Outcome after surgery was compared between those with and without delayed gastric emptying symptoms and a favorable outcome was defined as freedom from proton pump inhibitor (PPI) and 50% or more improvement in GERD-HRQL total score.
Abnormal gastric emptying study was defined as time to 50% emptying (T½) greater than 90 minutes or gastric retention >10% after 4 hrs. In a sub-analysis, patients with symptoms of DGE were divided into those with and without abnormal GE study and the outcome was compared between them.
Results:
A total of 516 patients (81%) did not have any preoperative symptoms suggestive for delayed gastric emptying. Preoperative symptoms of DGE were present in 120 patients (19%): 101 had a normal GE study and 19 had an abnormal GE study.
There was no significant difference between the rate of favorable outcome after MSA in patients with DGE symptoms compared to those with no DGE symptoms (77.3% vs. 78.3%, p=0.88). This was also true for % freedom from PPI (86.9% vs. 88.6%, p=0.71), mean DeMeester score [11.4 (13.3) vs. 13.3 (25.6), p=0.61] and rate of device removal (6.7% vs. 6%, p=0.9). However patients with DGE symptoms reported less satisfaction with the outcome of surgery compared to those with no DGE symptoms (77.9% vs. 86.3%, p=0.017).
Among patients with symptoms of DGE; there was no difference between the rate of favorable outcome in patients with an abnormal GE study compared to those with a normal GE study (76.9% vs. 78.1%, p=0.78). This was also true for % freedom from PPI, mean DeMeester score, rate of device removal and reported satisfaction with the outcome of surgery.
Conclusion:
Nineteen percent of the patients who underwent MSA in this cohort of 636 patients reported preoperative symptoms suggestive for DGE and completed a GE study. These patients had a similar subjective and objective outcome following MSA compared to those with no DGE symptoms. They were however less satisfied with the outcome of surgery. This is likely due to non-specific nature and multi-factorial etiology of these symptoms and needs to be addressed during preoperative counselling.
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