Surgical Management of Gastroesophageal Reflux Disease in Patients with Severe Esophageal Dysmotility

Armijo, Priscila Rodrigues; Hennings, Dietric; Leon, Melissa; Pratap, Akshay; Wheeler, Austin M.; Oleynikov, Dmitry

doi:10.1007/s11605-018-3968-6

Cited by 17 publications

(12 citation statements)

References 31 publications

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“…They again found similar results for 6-and 12-month outcome, demonstrating that fundoplication is a feasible treatment option for patients with absent contractility. 25 This current study is one of the largest cohorts of patients with absent contractility published, with a significant followup period. The results show that long-term postoperative outcomes for fundoplication in individuals with absent contractility appear comparable to those with normal motility.…”

Section: Discussionmentioning

confidence: 97%

Laparoscopic Fundoplication Is Effective Treatment for Patients with Gastroesophageal Reflux and Absent Esophageal Contractility

Tran

Gray

Kholmurodova

et al. 2021

Journal of Gastrointestinal Surgery

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Background Anti-reflux surgery in the setting of preoperative esophageal dysmotility is contentious due to fear of persistent long-term dysphagia, particularly in individuals with an aperistaltic esophagus (absent esophageal contractility). This study determined the long-term postoperative outcomes following fundoplication in patients with absent esophageal contractility versus normal motility. Methods A prospective database was used to identify all (40) patients with absent esophageal contractility who subsequently underwent fundoplication (36 anterior partial, 4 Nissen). Cases were propensity matched based on age, gender, and fundoplication type with another 708 patients who all had normal motility. Groups were assessed using prospective symptom assessment questionnaires to assess heartburn, dysphagia for solids and liquids, regurgitation, and satisfaction with surgery, and outcomes were compared. Results Across follow-up to 10 years, no significant differences were found between the two groups for any of the assessed postoperative symptoms. Multivariate analysis found that patients with absent contractility had worse preoperative dysphagia (adjusted mean difference 1.09, p = 0.048), but postoperatively there were no significant differences in dysphagia scores at 5- and 10-year follow-up. No differences in overall patient satisfaction were identified across the follow-up period. Conclusion Laparoscopic partial fundoplication in patients with absent esophageal contractility achieves acceptable symptom control without significantly worse dysphagia compared with patients with normal contractility. Patients with absent contractility should still be considered for surgery.

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Section: Discussionmentioning

confidence: 97%

Laparoscopic Fundoplication Is Effective Treatment for Patients with Gastroesophageal Reflux and Absent Esophageal Contractility

Tran

Gray

Kholmurodova

et al. 2021

Journal of Gastrointestinal Surgery

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“…Some previous studies reported that Nissen fundoplication enhanced LES pressure in patients with GERD and decreased the occurrence of TLESRs in both humans and animals (10–12). Although Nissen fundoplication was also reported to improve gastric motility (13), it does not improve esophageal motility (14, 15), and there were a variety of postoperative side effects, such as gas‐bloat syndrome, dysphagia, diarrhea, and recurrent heartburn in some patients (16, 17). In other words, although there are various therapeutic options, there is still a need to develop novel treatments for GERD.…”

Section: Introductionmentioning

confidence: 99%

Ameliorating Effects and Autonomic Mechanisms of Transcutaneous Electrical Acustimulation in Patients With Gastroesophageal Reflux Disease

Zhang

Shi

et al. 2020

Neuromodulation: Technology at the Neural Interface

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“…Laparoscopic Nissen fundoplication (LNF) has been proposed for patients with GERD and BE as an effective and safe therapeutic alternative, especially in cases where inadequate control of reflux symptoms is found during clinical treatment [20][21][22] . Although this may be true, there is still insufficient data related to the changes in esophageal motility and its evolution after surgical treatment of GERD and BE [23][24][25] . However, when successful, LNF provides less exposure to acid and bile salt content, reducing esophageal erosion and, consequently, diminished the metaplastic process present in BE 26,27 .…”

Section: Abstract Abstractmentioning

confidence: 99%

Does the nissen fundoplication procedure improve esophageal dysmotility in patients with barrett’s esophagus?

Falcäo

Nasi

Szachnowicz

et al. 2020

Rev. Col. Bras. Cir.

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Objective: to evaluate esophageal dysmotility (ED) and the extent of Barrett’s esophagus (BE) before and after laparoscopic Nissen fundoplication (LNF) in patients previously diagnosed with BE and ED. Methods: twenty-two patients with BE diagnosed by upper gastrointestinal (GI) endoscopy with biopsies and ED diagnosed by conventional esophageal manometry (CEM) were submitted to a LNF, and followed up with clinical evaluations, upper GI endoscopy with biopsies and CEM, for a minimum of 12 months after the surgical procedure. Results : sixteen patients were male (72.7%) and six were females (27.3%). The mean age was 55.14 (± 15.52) years old. and the mean postoperative follow-up was 26.2 months. The upper GI endoscopy showed that the mean length of BE was 4.09 cm preoperatively and 3.91cm postoperatively (p=0.042). The evaluation of esophageal dysmotility through conventional manometry showed that: the preoperative median of the lower esophageal sphincter resting pressure (LESRP) was 9.15 mmHg and 13.2 mmHg postoperatively (p=0.006). The preoperative median of the esophageal contraction amplitude was 47.85 mmHg, and 57.50 mmHg postoperatively (p=0.408). Preoperative evaluation of esophageal peristalsis showed that 13.6% of the sample presented diffuse esophageal spasm and 9.1% ineffective esophageal motility. In the postoperative, 4.5% of patients had diffuse esophageal spasm, 13.6% of aperistalsis and 22.7% of ineffective motor activity (p=0.133). Conclusion: LNF decreased the BE extension, increased the LES resting pressure, and increased the amplitude of the distal esophageal contraction; however, it was unable to improve ED.

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Surgical Management of Gastroesophageal Reflux Disease in Patients with Severe Esophageal Dysmotility

Cited by 17 publications

References 31 publications

Laparoscopic Fundoplication Is Effective Treatment for Patients with Gastroesophageal Reflux and Absent Esophageal Contractility

Laparoscopic Fundoplication Is Effective Treatment for Patients with Gastroesophageal Reflux and Absent Esophageal Contractility

Ameliorating Effects and Autonomic Mechanisms of Transcutaneous Electrical Acustimulation in Patients With Gastroesophageal Reflux Disease

Does the nissen fundoplication procedure improve esophageal dysmotility in patients with barrett’s esophagus?

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