GI SurgeryImpedance planimetry (EndoFLIP) measurements persist long term after anti-reflux surgery
Introduction
Laparoscopic Anti-Reflux Surgery (LARS) includes Nissen Fundoplication, Toupet Fundoplication, and recently Magnetic Sphincter Augmentation (MSA). The durability of each operation is typically assessed through patient-reported outcomes unless severe symptoms recur leading to additional evaluation. This would include an esophagram, endoscopy, acid monitoring, or manometry. New technology such as impedance planimetry based on the functional lumen imaging probe (FLIP) can provide geometric measurements of the gastroesophageal junction and quantify the tightness of a sphincter. Tightness, calculated as the distensibility index through FLIP during LARS, has been shown to predict patient outcomes.1,2 Collecting FLIP values during postoperative endoscopy present a unique opportunity to examine the durability of sphincter augmentation over time. We aim to describe our institutional experience in performing FLIP during postoperative esophagogastroduodenoscopy (EGD) after LARS.
Section snippets
Data collection
All patients who had postoperative EGD with FLIP between March 2018 and June 2021 were included. Patients had their index LARS from November 2003 to February 2020 meaning a portion of this cohort did not undergo intraoperative FLIP evaluation because we started using FLIP in 2013 for fundoplication and 2016 for MSA. Dedicated research fellows perform the FLIP evaluation in the operating room and collect data during each case. The surgeon (M.B.U.) performs FLIP evaluation in the procedure suite
Patient demographics and QOL questionnaire responses
Fifty-eight patients had primary LARS (Nissen fundoplication 35%, Toupet fundoplication 41%, LINX 24%) from November 2003 to February 2020, this includes 5 patients who had their index operation at an outside hospital. Postoperative EGD with FLIP was performed at a median (Q1-Q3) 16 (11−31) months after surgery from March 2018 to June 2021. Reason for EGD included Barrett’s Esophagus Surveillance, dysphagia, symptomatic GERD, or no symptoms (routine GERD surveillance). Symptomatic GERD was the
Discussion
The surgical management of GERD includes restoring the native anti-reflux barriers of the gastroesophageal junction. This can be done through Nissen fundoplication, Toupet fundoplication, or Magnetic Sphincter Augmentation. Patients are hesitant to commit to surgical management, because of fearful side effects such as dysphagia and gas-bloat syndrome. Surgeons evolved their techniques to reduce these side effects, which include shortening the length of fundoplication, increasing bougie
Funding/Support
None.
Conflict of interest/Disclosure
John Linn is a lecturer for Gore. Michael B. Ujiki is a board member for Boston Scientific, is a paid consultant for Olympus and Cook, and is a lecturer for Medtronic, Erbe, and Gore.
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