THE CHALLENGE OF DIAGNOSTIC ASSESSMENT OF A FAILED FUNDOPLICATION: THE CHALLENGE OF DIAGNOSTIC ASSESSMENT OF A FAILED FUNDOPLICATION: BENEFITS OF HIGH RESOLUTION MANOMETRY OF THE GE-JUNCTIONBENEFITS OF HIGH RESOLUTION MANOMETRY OF THE GE-JUNCTION

Residual pressures of post-fundoplication patients and normal controls

Dysphagia No Dysphagia Normals 0

10

20

30

p<0.01 p=n.s.

mm

Hg

(n=17) (n=11) (n=50)

Intrabolus Pressures of post-fundoplication patients and normal controls

Dysphagia No Dysphagia Normals 0

10

20

30

40

p=n.s. p<0.05

p<0.01

mm

Hg

(n=17) (n=11) (n=50)

Attila Dubecz MD; Renato Salvador MD; Marek Polomsky MD; Thomas J. Watson MD; Carolyn Jones MD; Jeffrey H. Peters MD Department of Surgery, University of Rochester, School of Medicine and Dentistry, Rochester, NY

BackgroundBackground

StudyStudy AimAim

ConclusionsConclusions

Functional information allowing insight into the cause of recurrent symptoms in symptomatic patients following failed fundoplication can be key to clinical decision making.

Evaluate manometric signs of outflow obstruction in patients with post-fundoplication dysphagia.

•HRM revealed high residual pressures, low percent LES relaxations and high intrabolus pressure of the neo-high pressure zone in virtually all patients with post-fundoplication dysphagia.

•The image based analysis and high density of recording sides coupled with software interpolation available in HRM, allows novel and clinically useful observations in the evaluation of complex esophageal pathology.

Patients and Methods Patients and Methods

ResultsResults

Patients: 28 patients (5 male / 23 female)

Symptoms: 17 dysphagia, 8 chestpain, 5 heartburn, 5 regurgitation, 2 cough, 2 vomiting

Manometric Data-acquisition and Analysis:

ManoScan & ManoViewTM (Sierra Scientific Instruments)

Intrabolus pressures: MATLABTM

Impaired Relaxation

High Intrabolus Pressure

Percent LES Relaxation of post-fundoplication patients andnormal controls

Dysphagia No Dysphagia Normals 0

20

40

60

80

100

p<0.01 p=n.s.

%

LE

S r

elax

atio

n

(n=17) (n=11) (n=45)

Manometric signs of outflow obstructionIntrabolus Pressure >20mmHgLES Residual Pressure >15 mmHgPercent LES Relaxation <57%

We compared the manometric results of post-fundoplication patients with and without dysphagia with 50 healthy controls.

 

# of Patients with Manometric Evidence of Outflow Obstruction (any of

3) Total %  Dysphagia 16 17 94

p<0.001No Dysphagia 3 11 27

Two Distal High Pressure Zones (LES and Diaphragmatic Crura)