Document Detail

The value of multiple rapid swallows during preoperative esophageal manometry before laparoscopic antireflux surgery.
MedLine Citation:
PMID:  22648115     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: When multiple swallows are rapidly administered, esophageal peristalsis is inhibited, and pronounced lower esophageal sphincter relaxation ensues. After the last swallow of the series, a robust contraction sequence results. The authors hypothesize that multiple rapid swallows (MRS) may have value in predicting esophageal transit symptoms in patients undergoing laparoscopic antireflux surgery (LARS).
METHODS: Records of patients undergoing esophageal high-resolution manometry (HRM) before LARS were evaluated. The evaluation of MRS included adequate inhibitory response during swallows and the contraction pattern after MRS. Dysphagia was scored based on a product of symptom frequency and severity using 5-point Likert scales. A composite dysphagia score comprised the sum of scores for solid and liquid dysphagia, and a score of 4 or higher was considered clinically significant. The normal and abnormal MRS responses of patients with preoperative, early, and late postoperative dysphagia were compared with those of patients with no dysphagia.
RESULTS: In this study, 63 patients (mean age, 60.3 ± 1.7 years, 48 women) undergoing HRM before LARS successfully performed MRS (median, 5 swallows; longest interval between swallows, 3.2 ± 0.1 s). After MRS, 14 patients (22.2%) had an intact peristaltic sequence. Complete failure of peristalsis was seen in 21 (33.3%), and incomplete esophageal inhibition in 25 (39.7%) of the remaining patients. When stratified by presence or absence of dysphagia, 58.3% of the subjects without dysphagia had a normal MRS response, whereas 83.3% had formation of peristaltic segments after MRS. In contrast, only 14% of the subjects with dysphagia had a normal MRS response (p ≤ 0.003 vs. the subjects with no dysphagia). Abnormal MRS responses were more prevalent in the patients with any preoperative and late postoperative dysphagia (p = 0.04 across groups) and in those with clinically significant dysphagia (p = 0.08 across groups).
CONCLUSIONS: High-resolution manometry with MRS helps to predict dysphagia in subjects undergoing preoperative esophageal function testing before LARS.
Nathaniel Stoikes; Jesse Drapekin; Vladimir Kushnir; Anisa Shaker; L Michael Brunt; C Prakash Gyawali
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Publication Detail:
Type:  Journal Article     Date:  2012-05-31
Journal Detail:
Title:  Surgical endoscopy     Volume:  26     ISSN:  1432-2218     ISO Abbreviation:  Surg Endosc     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-26     Completed Date:  2013-05-06     Revised Date:  2014-08-10    
Medline Journal Info:
Nlm Unique ID:  8806653     Medline TA:  Surg Endosc     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  3401-7     Citation Subset:  IM    
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MeSH Terms
Gastroesophageal Reflux / physiopathology*,  surgery*
Manometry / methods*
Middle Aged
Preoperative Care
Prospective Studies
Time Factors
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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