Back to 2025 Posters
LAPAROSCOPIC ANTI-REFLUX SURGERY AS PRIMARY TREATMENT FOR INEFFECTIVE ESOPHAGEAL MOTILITY DUE TO GERD
Yassmin Hegazy
*1, Jeremy Morgan
1, Andrew Seals
1, Mary Evans
1, Grace Howell
1, Chloe Lee
2, Venkata Seerapu
1, Eldrin Bhanat
1, Jacob R. Moremen
11Gastroenterology, University of Mississippi School of Medicine, Jackson, MS; 2Keesler Air Force Base, Biloxi, MS
Introduction:
Ineffective Esophageal Motility (IEM) is the most common motility abnormality in patients with chronic gastroesophageal reflux disease (GERD). Patients with untreated IEM have impaired peristalsis leading to an increased risk of GERD-related complications. Although laparoscopic anti-reflux surgery (LARS) is a standard therapy for GERD, its use in IEM is controversial due to the risk of dysphagia. Our study evaluated the symptom outcomes of patients with IEM due to GERD who underwent LARS to determine its safety and efficacy as primary treatment.
Methods:
We retrospectively evaluated patients who underwent LARS for GERD who demonstrated IEM on pre-operative high-resolution manometry (HRM). Study participants included adults with IEM based on the Chicago 3 classification defined as normal integrated relaxation pressure (IRP) and at least 50% ineffective swallows. Data was collected from the electronic medical record. Results were measured as means and standard deviations for continuous variables and frequencies and percentages for categorical variables.
Results:
Our review evaluated 31 patients (68% female, 58% white) who underwent LARS for IEM. Mean age was 62.4 and mean BMI was 28.5 kg/m2 (+/- 4.5). Other characteristics and chief complaints are listed in Table 1. HRM revealed mean DCI of 503 (0-2321, SD 518), mean failed swallow percentage of 77.1 (50-100, standard deviation (SD) 16.0), and mean IRP of 4.7 (-11-23, SD 8.1). Pre-operative pH study was performed in 56.7% with a mean Demeester score of 32.6 (0-73.6, SD 23.7). All patients underwent laparoscopic or robotic hiatal hernia repair; 23.3% were redo operations. In patients presenting with dysphagia (22/31, 71%), 70.7% reported resolution at the 1st post-op visit. The mean rate of resolution of dysphagia and regurgitation by last follow-up was 78.4% and 83.7% respectively (Figure 1). Five patients underwent subsequent dilations, all but one had originally presented with dysphagia. Readmission within 30 days occurred in 6.7% and complications in 33.3% consisting of 2 new oxygen requirements, 2 pleural effusions, 1 deep vein thrombosis (DVT), and 5 Emergency Room visits for dysphagia.
Conclusion:
Laparoscopic anti-reflux surgery (LARS) resulted in significant symptomatic quality of life benefit in our patient cohort with minimal complications. Even in patients with poor motility, LARS can improve dysphagia and regurgitation with low rate of serious complications and no worsening or generation of new dysphagia. Our study shows that LARS should be considered as a primary treatment option for patients presenting with dysphagia and GERD related to IEM.
Back to 2025 Posters
