A novel EndoFLIP marker during hiatal hernia repair is associated with short-term postoperative dysphagia.

Autor: Shah A; Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA., Nguyen DT; Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA., Meisenbach LM; Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA., Chihara R; Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.; Department of Surgery and Cardiothoracic Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA., Chan EY; Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.; Department of Surgery and Cardiothoracic Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA., Graviss EA; Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.; Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA., Kim MP; Department of Surgery and Cardiothoracic Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA. mpkim@houstonmethodist.org.; Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, 6550 Fannin Street, Suite 1661, Houston, TX, 77030, USA. mpkim@houstonmethodist.org.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2022 Jul; Vol. 36 (7), pp. 4764-4770. Date of Electronic Publication: 2021 Oct 28.
DOI: 10.1007/s00464-021-08817-z
Abstrakt: Background: Endoluminal functional lumen imaging probe (EndoFLIP) provides an objective measure of the distensibility index (DI) during different parts of hiatal hernia repair. However, the absolute DI measure above a cut-off after creating a barrier alone has not shown a relationship to dysphagia after surgery. We wanted to determine if the change in DI with volume change is associated with dysphagia.
Methods: We included patients who had hiatal hernia repair with EndoFLIP values, including two values taken at the end of the surgical case with different volumes of fluid in the balloon (30 mL and 40 mL). We compared the absolute and change in DI during hiatal hernia repair and performed an analysis to determine if there was a correlation with short-term clinical outcomes.
Results: A total of 103 patients met the inclusion and exclusion criteria. Most of the patients underwent Toupet fundoplication (n = 56, 54%), followed by magnetic sphincter augmentation (LINX, n = 28, 27%) and Nissen fundoplication (n = 19, 18%). There was a significant reduction in the DI from the initial DI taken after mobilization of the hiatus (3 mm 2 /mmHg) and after the creation of the barrier (1.4 mm 2 /mmHg, p < 0.001). A minority of patients had a decrease or no change in the DI with an increase in balloon volume increased from 30 to 40 mL (n = 37, 36%). Overall, after 1 month, there was a significant decrease in the GERD-HRQL score from 23 to 4 (p < 0.001) and bloat score from 3 to 2 (p = 0.003) with a non-significant decrease in the dysphagia score from 1 to 0 (p = 0.11). Patients who had a decreased or unchanged DI with an increase in the balloon volume from 30 to 40 mL had a significant decrease in their dysphagia score by 2 points (p = 0.04).
Conclusion: The decreased or unchanged DI with an increase in the balloon volume on EndoFLIP is associated with a significant reduction in dysphagia after surgery. The decrease in DI denotes the esophagus's ability to create higher pressure relative to the change in the cross-sectional area with a larger bolus across the gastroesophageal junction. This measure may be a new marker that can predict short-term outcomes in patients undergoing hiatal hernia repair.
(© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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