ArticleSurgical endoscopy2023
Components of high-resolution manometry that change surgical decisions.
Article in Surgical endoscopy, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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4 authors.
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Abstract
backgroundHigh-resolution manometry (HRM) is vital in evaluating patients for surgery at the gastroesophageal (GE) junction. Previously, we reported manometry alters surgery choices at the GE junction over 50% of the time, and its components, i.e., abnormal motility and distal contractile integral (DCI), are vital in decision-making. This single-institution retrospective study examines how HRM characteristics, reported with the Chicago classification, can alter the intended surgical plans for foregut surgery.
methodsWe collected data on pre-operative symptoms for patients undergoing HRM studies from 2012 to 2016, i.e., Upper GI X-rays, 48-h pH studies, DeMeester scores, upper endoscopy, and biopsy reports. HRM results were further categorized via Chicago classification (i.e., normal or abnormal motility). The DCI was determined; Patients not seen by a surgeon were excluded. Then a single surgeon, blinded to patient identity and HRM results, determined the planned procedure. The reviewer was then exposed to the HRM results; procedural plans were revised if needed. HRM results were then evaluated to determine which factors most influenced the surgical decisions.
results298 HRM studies were initially identified; 114 met search criteria. Overall, HRM altered the planned procedure in 50.9% of cases (n = 58), with abnormal motility in 54.4% (62/114) cases. Abnormal motility findings corresponded to 70.6% (41/58) of the patients in which HRM changed the surgery decision. A DCI of < 1000 was identified in only 31.6% (36/114) of all patients, but 39.7% (23/58) of cases where the surgical decision was altered. A DCI of > 5000 was identified in only 10.5% (12/114) of all patients but 10.3% (6/58) of cases with altered surgical decisions. A DCI < 1000 and abnormal motility were generally associated with a partial fundoplication.
conclusionsThis study demonstrates the impact of identifying abnormal motility via the Chicago classification and factors like DCI on surgical choice at the GE junction.
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