Predictive value of preoperative esophagram in postoperative outcomes after antireflux surgery.

Adam De Jesus, Brooklynn Rylee Rickett, Matthew Smith, Sean Phillip Duminie, David Harris, Amber Shada, Anne Lidor

Abstract read

In one paragraph

Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it

0cells of the map it votes in

0citing papers in PubMed

–field-weighted citation impact

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Adam De JesusDepartment of Surgery, Health Sciences Learning Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, 750 Highland Ave, Madison, WI, 53726, USA.

Brooklynn Rylee RickettDepartment of Surgery, Health Sciences Learning Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, 750 Highland Ave, Madison, WI, 53726, USA. brickett@wisc.edu.ORCID http://orcid.org/0009-0005-9864-8095

Matthew SmithDepartment of Surgery, Health Sciences Learning Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, 750 Highland Ave, Madison, WI, 53726, USA.

Sean Phillip DuminieDepartment of Surgery, Health Sciences Learning Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, 750 Highland Ave, Madison, WI, 53726, USA.

David HarrisDepartment of Surgery, Health Sciences Learning Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, 750 Highland Ave, Madison, WI, 53726, USA.

Amber ShadaDepartment of Surgery, Health Sciences Learning Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, 750 Highland Ave, Madison, WI, 53726, USA.

Anne LidorDepartment of Surgery, Health Sciences Learning Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, 750 Highland Ave, Madison, WI, 53726, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundGastroesophageal reflux disease (GERD) significantly impairs quality of life. Antireflux surgery (ARS) improves symptoms when medical therapy fails, but postoperative recurrence and dysphagia remain concerns, emphasizing the need for improved preoperative risk stratification. This study evaluates whether esophageal transit time (ETT) measured on standard preoperative esophagram can predict postoperative outcomes after ARS and serve as an accessible method to characterize esophageal motility on esophagram and assist in preoperative decision-making.

methodsIn this retrospective cohort study, 174 patients underwent Nissen or Toupet fundoplication (± hiatal hernia repair) between 2014-2025 at a tertiary academic center. Patients were required to have preoperative esophagram and ≥ 1 postoperative Health-Related Quality of Life (HRQL) follow-up; 92 patients also had high-resolution manometry. Preoperative esophagrams were independently reviewed by a subspecialized radiologist blinded to clinical outcomes. ETT was correlated with manometric findings and postoperative HRQL scores.

resultsReceiver Operating Characteristic (ROC) analysis identified ETT threshold ≥ 5.375 s as associated with greater long-term symptom burden across all patient-reported outcome domains at 3-5 years (p < 0.05). Longer ETT was associated with more failed contractions and weaker distal esophageal contractions on manometry, and ETT showed sensitivity of 75-83%, specificity of 35-46%, positive predictive value (PPV) of 15-55%, negative predictive value (NPV) of 71-94%, positive likelihood ratio (LR +) (1.22-1.54), and negative likelihood ratio (LR-) (0.37-0.65).

conclusionETT greater than 5.375 s was associated with greater long-term symptom burden across all patient-reported outcome domains. Longer ETT correlated with higher percentages of failed contractions and lower distal esophageal contraction amplitude on manometry supporting physiologic relevance. While specificity is low, high NPV suggests ETT less than 5.375 s may serve as a simple, noninvasive screening to help exclude severe dysmotility and reduce reliance on manometry in selected patients. These findings support using ETT as an adjunctive risk-stratification measure to assist in preoperative decision-making rather than a standalone prognostic test.

Indexed as

EsophagusFundoplicationGastroesophageal RefluxAgedFemaleGastrointestinal TransitHumansMaleManometryMiddle AgedPredictive Value of TestsPreoperative CareQuality of LifeRetrospective StudiesTreatment OutcomeEsophageal transit timeEsophagramGastroesophageal reflux diseaseHiatal herniaManometryNissen fundoplication

Identifiers

PMID42538396

DOI10.1007/s00464-026-13126-4

What OpenQuestion holds

Textmetadata

Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.