Abstracts
1997 Digestive Disease Week

Cisapride enhances the effect of the Toupet fundoplication on esophageal peristalsis in GERD patients with poor esophageal body motility.

GJ Wetscher, K Glaser, T Wieschemeyer, A Klingler, P Klingler, RA Hinder. Departments of Surgery, University of Innsbruck, Austria, and Mayo Clinic, Jacksonville, FL.

Partial posterior fundoplication (Toupet fundoplication) improves esophageal peristalsis in GERD patients with poor esophageal body motility. The aim of this study was to investigate whether the postoperative administration of cisapride, which is a prokinetic drug, enhances the effect of surgery on esophageal peristalsis.

Methods: The laparoscopic Toupet fundoplication was performed on 34 consecutive GERD patients with poor esophageal body motility. These patients were randomized in groups, without and with postoperative medication with cisparide (20 mg twice daily for 6 months). Esophageal manometry was performed preoperatively and 6 months after surgery. The amplitudes (mmHg) in the distal esophagus, the number (%) of amplitudes < 30mmHg in the distal esophagus, the number (%) of interrupted and the total number (%) of defective contraction waves (= interrupted waves + simultaneous waves + waves with amplitudes < 30mmHg) were quoted.

Results: Data of pre- and postoperative manometry are shown in the table (median + interquartile range). There was a significant (p<0.05) improvement of all parameters of esophageal body motility following surgery with and without additional treatment with cisapride. However, this effect was more pronounced in patients receiving cisapride.

                                no cisapride             cisapride
                              preop.    postop.       preop.   postop.
 amplitudes                    30.6      44.4          34.6      54.1
                              (15-38)   (25-97)      (27-44)  (41-67)
 No. amplitudes < 30 mmHg       50        15           35        0
                              (2o-65)   (5-45)       (25-45)   (5-15)
 No. interrupted waves          30        15           30        0
                              (2o-65)   (5-45)       (25-45)   (5-15)
 No. defective contractions     80        40           70        15
                              (55-95)   (15-85)      (65-80)   (5-25)

Conclusion: The Toupet fundoplication combined with postoperative administration of cisapride should be the treatment of choice for GERD patients with poor esophageal body motility.