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Surg Endosc. 2012 Dec;26(12):3401-7. doi: 10.1007/s00464-012-2350-0. Epub 2012 May 31.

The value of multiple rapid swallows during preoperative esophageal manometry before laparoscopic antireflux surgery.

Author information

1
Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.

Abstract

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.

PMID:
22648115
PMCID:
PMC4098863
DOI:
10.1007/s00464-012-2350-0
[Indexed for MEDLINE]
Free PMC Article

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