THE IMPACT OF OBJECTIVE COLONIC AND WHOLE GUT MOTILITY DATA AS MEASURED BY WIRELESS MOTILITY CAPSULE ON THE OUTCOMES OF ANTI-REFLUX SURGERY
Sven Eriksson*2, Nicole Maurer2,1, Rachel Mcgurk2, Ann DeWitt2, Ping Zheng2, Ali H. Zaidi2, Blair Jobe2,1, Shahin Ayazi2,1
1Drexel University, Philadelphia, PA; 2Allegheny Health Network, Pittsburgh, PA
Introduction:
Studies have shown higher rates of dissatisfaction with outcome following anti-reflux surgery (ARS) in patients with chronic constipation. This suggests a relationship between colonic dysmotility and suboptimal outcome after ARS. However, due to limitations in technology, there is no objective data available examining this relationship. The wireless motility capsule (WMC) is a novel technology consisting of an ingestible capsule equipped with pH, temperature, and pressure sensors, which provide information regarding regional and whole gut transit times, pH and motility within a single test. The aim of this study was to assess how objective regional and whole gut motility data impact ARS outcomes.
Material and methods:
This was a retrospective review of prospectively collected data from 48 patients who underwent WMC testing prior to fundoplication (n=29) or magnetic sphincter augmentation (MSA) (n=19) at our institution over a 4 year period. Gastric emptying time (GET), small bowel transit time (SBTT), colonic transit time (CTT), whole gut transit time (WGTT), antral motility index (aMI), duodenal motility index (dMI), regional pH (stomach, antrum, duodenum, small bowel, colon), and regional pressure (stomach, antrum, duodenum, small bowel, colon) were used in analysis to determine factors that impact surgical outcome. Favorable outcome after ARS was defined as complete resolution of the primary reflux symptom and freedom from proton pump inhibitors (PPIs).
Results:
The final study population consisted of 48 patients (87.5% female) with a mean (SD) age of 51.8 (15.0) and BMI of 29.0 (4.2). At a mean (SD) follow up of 16.8 (13.2) months, 89.6% of patients had complete primary symptom relief and 93.7% were free from PPIs. Favorable outcome was achieved in 87.5% of all patients, 82.8% of patients who underwent fundoplication and 94.7% of those who underwent MSA.
Patients with unfavorable outcome had a longer mean CTT (78.6 hours vs. 47.3 hours; p=0.025), higher mean peak colonic pH (8.55 vs. 8.15; p=0.006) and higher mean aMI (310 vs. 90.1; p=0.50). They were also found to have a longer mean WGTT (55.7 hours vs. 44.6 hours; p=0.021), however of the three components that make up WGTT (GET, SBTT, CTT), only CTT was significantly different between two groups. Peak pH in stomach, antrum, duodenum, and small bowel, and all regional pressures were not significantly different between two groups.
Conclusion:
This is the first study using an objective measure of colonic physiology to demonstrate that delayed colonic motility leads to poor outcomes after anti-reflux surgery. Wireless motility capsule testing can assist with pre-operative risk assessment and counselling for patients seeking anti-reflux surgery.
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