Journal article
Measurement of outflow resistance imposed by magnetic sphincter augmentation: defining normal values and clinical implication
Surgical endoscopy, v 35(10), pp 5787-5795
01 Oct 2021
PMID: 33051761
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Introduction
No manometric criteria have been defined to select patients for magnetic sphincter augmentation (MSA). The first step to establish such criteria is to measure the outflow resistance at esophagogastric junction (EGJ) imposed by MSA. This resistance needs to be overcome by the esophageal contraction in order for the esophagus to empty and to avoid postoperative dysphagia. This study was designed to measure the outflow resistance caused by MSA in patients free of postoperative dysphagia.
Methods
Records of the patients who underwent MSA in our institution were reviewed. A group of MSA patients with excellent functional outcome, who were free of clinically significant postoperative dysphagia, were selected. These patients then underwent high-resolution impedance manometry (HRIM) at a target date of 1 year after surgery. The outflow resistance was measured by the esophageal intrabolus pressure (iBP) recorded 2 cm proximal to the lower esophageal sphincter (LES).
Results
The study population consisted of 43 patients. HRIM was performed at mean of 20.4 (10.4) months after surgery. The mean (SD) amplitude of the iBP was 13.5 (4.3) before surgery and increased to 19.1 (5.6) after MSA (
p
< 0.0001). Patients with a smaller size LINX device (≤ 14 beads) had a similar iBP when compared to those with a larger device (> 15 beads) [19.7 (4.5) vs. 18.4 (5.9),
p
= 0.35]. There was a significant correlation between the iBP and % incomplete bolus clearance [Spearman
R
: 0.44 (95% CI 0.15–0.66),
p
= 0.0032]. The 95th percentile value for iBP after MSA was 30.4 mmHg.
Conclusion
The EGJ outflow resistance measured by iBP is increased after MSA. The upper limit of normal for iBP is 30 mmHg in this cohort of patients who were free of dysphagia after MSA. This degree of resistance needs to be overcome by distal esophageal contraction and will likely be requisite to prevent persistent postoperative dysphagia.
Metrics
Details
- Title
- Measurement of outflow resistance imposed by magnetic sphincter augmentation: defining normal values and clinical implication
- Creators
- Shahin Ayazi - Allegheny Health NetworkAndrew D. Grubic - Allegheny Health NetworkPing Zheng - Allegheny Health NetworkAli H. Zaidi - Allegheny Health NetworkKatrin Schwameis - Allegheny Health NetworkAdam C. Alleyne - Allegheny Health NetworkBrittney M. Myers - Allegheny Health NetworkAshten N. Omstead - Allegheny Health NetworkBlair A. Jobe - Allegheny Health Network
- Publication Details
- Surgical endoscopy, v 35(10), pp 5787-5795
- Publisher
- Springer US
- Number of pages
- 9
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:000578284500004
- Scopus ID
- 2-s2.0-85092497908
- Other Identifier
- 991022048290404721
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- Surgery