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Factors affecting the treatment outcomes of laparoscopic fundoplication for erosive reflux esophagitis: findings of esophageal pathological function tests

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Abstract

Purpose

To identify the factors that affect laparoscopic fundoplication (LF) treatment efficacy in patients with erosive gastroesophageal reflux disease (e-GERD) esophagitis, based on the findings of multichannel intraluminal impedance pH (MII-pH) and high-resolution manometry (HRM).

Methods

The subjects were 102 patients with e-GERD diagnosed by endoscopy, who underwent LF as the initial surgery. To analyze the findings of MII-pH and HRM, the patients were divided into two groups: a cured group (CR), comprised of patients whose esophagitis was cured postoperatively; and a recurrence group (RE), comprised of patients who suffered recurrent esophagitis.

Results

There were 96 patients in the CR group and 6 in the RE group. MII-pH indicated that the acid reflux time, the longest reflux time, and the number of refluxes longer than 5 min, were significantly higher in the RE group than in the CR group (p = 0.0028, p = 0.0008, p = 0.012, respectively). The HRM indicated that only the distal contractile integral (DCI) was significantly lower in the RE group (p = 0.0109).

Conclusion

The results of this study indicate that esophageal clearance may affect the treatment outcome of LF. Based on the findings of MII-pH, the longest reflux time and the number of refluxes longer than 5 min were important factors influencing the therapeutic effect, whereas based on the HRM, the DCI value was most important.

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References

  1. Lundell LR, Dent J, Bennett JR, Blum AL, Armstrong D, Galmiche JP, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45(2):172–802.

    Article  CAS  Google Scholar 

  2. Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101(8):1900–20.

    Article  Google Scholar 

  3. Emerenziani S, Habib FI, Ribolsi M, Caviglia R, Guarino MP, Petitti T, et al. Effect of hiatal hernia on proximal oesophageal acid clearance in gastro-oesophageal reflux disease patients. Aliment Pharmacol Ther. 2006;23(6):751–7.

    Article  CAS  Google Scholar 

  4. Johnson LF, DeMeester TR. Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux. Am J Gastroenterol. 1974;62(4):325–32.

    CAS  PubMed  Google Scholar 

  5. Shay S, Tutuian R, Sifrim D, Vela M, Wise J, Balaji N, et al. Twenty-four hour ambulatory simultaneous impedance and pH monitoring: a multicenter report of normal values from 60 healthy volunteers. Am J Gastroenterol. 2004;99(6):1037–43.

    Article  Google Scholar 

  6. Yano F, Omura N, Tsuboi K, Hoshino M, Yamamoto SR, Akimoto S, et al. Standard values of 24-h multichannel intraluminal impedance-pH monitoring for the Japanese. Esophagus. 2017;14(1):91–6.

    Article  Google Scholar 

  7. Yadlapati R. High-resolution esophageal manometry: interpretation in clinical practice. Curr Opin Gastroenterol. 2017;33(4):311–9.

    Article  Google Scholar 

  8. Hunter JG, Smith CD, Branum GD, Waring JP, Trus TL, Cornwell M, et al. Laparoscopic fundoplication failures: patterns of failure and response to fundoplication revision. Ann Surg. 1999;230(4):595–606.

    Article  CAS  Google Scholar 

  9. Hoshino M, Omura N, Yano F, Tsuboi K, Yamamoto SR, Akimoto S, et al. Impact of reflux esophagitis on the esophageal function before and after laparoscopic fundoplication. Esophagus. 2018;15(4):224–30.

    Article  Google Scholar 

  10. El-Selag HB, Sonnenberg A. Outcome of erosive reflux esophagitis after Nissen fundoplication. Am J Gastroenterol. 1999;94(7):1771–6.

    Article  Google Scholar 

  11. Isolauri J, Luostarinen M, VilJakka M, Isolauri E, Keyrilainen O, Karvonen AL. Long-term comparison of antireflux surgery versus conservative therapy for reflux esophagitis. Ann Surg. 1997;225(3):295–9.

    Article  CAS  Google Scholar 

  12. Omura N, Kashiwagi H, Yano F, Tsuboi K, Yanaga K. Characteristics of symptomatic GERD in Japanese patients based on 24-h pH monitoring. J Gastroenterol. 2005;40:791–5.

    Article  Google Scholar 

  13. Tsuboi K, Omura N, Yano F, Hoshino M, Yamamoto SR, Akimoto S, et al. Effect of preoperative balloon dilation on treatment outcomes of laparoscopic Heller-Dor surgery for achalasia: a propensity score matched study. Surg Today. 2018;48(12):1068–75.

    Article  Google Scholar 

  14. Hoshino M, Omura N, Yano F, Tsuboi K, Yamamoto SR, Akimoto S, et al. Backflow prevention mechanism of laparoscopic Toupet fundoplication using high-resolution manometry. Surg Endosc. 2016;30(7):2703–10.

    Article  Google Scholar 

  15. Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, International High Resolution Manometry Working Group, et al. The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27(2):160–74.

    Article  CAS  Google Scholar 

  16. Hoshino M, Omura N, Yano F, Tsuboi K, Yamamoto SR, Akimoto S, et al. Comparison of the multichannel impedance pH and conventional pH for measuring esophageal acid exposure: a propensity score-matched analysis. Surg Endosc. 2017;31(12):5241–7.

    Article  Google Scholar 

  17. Bancewicz J, Matthews HR, O’Hanrahan T, Adams I. A comparison of surgically treated reflux patients in two surgical centers. In: Little AG, Ferguson MK, Skinner DB, editors. Diseases of the esophagus. Mount Kisco: Oxford Academic; 1990. p. 177–80.

    Google Scholar 

  18. Ismail T, Bancewicz J, Barlow J. Yield pressure, anatomy of the cardia and gastro-oesophageal reflux. Br J Surg. 1995;82(7):943–7.

    Article  CAS  Google Scholar 

  19. Omura N, Tsuboi K, Yano F. Minimally invasive surgery for large hiatal hernia. Ann Gastroenerol Surg. 2019;3(5):487–95.

    Article  Google Scholar 

  20. Sandhu DS, Fass R. Current trends in the management of gastroesophageal reflux disease. Gut Liver. 2018;12(1):7–16.

    Article  CAS  Google Scholar 

  21. Tutuian R, Castell DO. Review article: complete gastro-oesophageal reflux monitoring combined pH and impedance. Aliment Pharmacol Ther. 2006;24(2):27–37.

    Article  Google Scholar 

  22. Sidhwa F, Moore A, Alligood E, Fisichella PM. Diagnosis and treatment of the extraesophageal manifestations of gastroesophageal reflux disease. Ann Surg. 2017;265(1):63–7.

    Article  Google Scholar 

  23. Gyawali CP, Kahrilas PJ, Savarino E, Zerbib F, Mion F, Smout AJPM, et al. Modern diagnosis of GERD : the Lyon consensus. Gut. 2018;67(7):1351–62.

    Article  Google Scholar 

  24. Garbarino S, Horton A, Patel A. The utility of esophageal motility testing in gastroesophageal reflux disease. Curr Gastroenterol Rep. 2019;21(8):37. https://doi.org/10.1007/s11894-019-0704-7.

    Article  PubMed  Google Scholar 

  25. Dallemagne B, Weerts JM, Jehaes C, Markiewicz S, Lombard R. Laparoscopic Nissen fundoplication: preliminary report. Surg Endosc. 1991;1(3):138–43.

    CAS  Google Scholar 

  26. Omura N, Yano F, Tsuboi K, Hoshino M, Yamamoto SR, Akimoto S, et al. Surgical results of laparoscopic Toupet fundoplication for gastroesophageal reflux disease with special reference to recurrence. Esophagus. 2018;15(4):217–23.

    Article  Google Scholar 

  27. Broeders JA, Rijnhart-de Jong HG, Draaisma WA, Bredenoord AJ, Smout AJ, Gooszen HG. Ten-year outcome of laparoscopic and conventional nissen fundoplication: randomized clinical trial. Ann Surg. 2009;250(5):698–706.

    Article  Google Scholar 

  28. Mardani J, Lundell L, Engström C. Total or posterior partial fundoplication in the treatment of GERD: results of a randomized trial after 2 decades of follow-up. Ann Surg. 2011;253(5):875–8.

    Article  Google Scholar 

  29. Engström C, Cai W, Irvine T, Devitt PG, Thompson SK, Game PA, et al. Twenty years of experience with laparoscopic antireflux surgery. Br J Surg. 2012;99(10):1415–21.

    Article  Google Scholar 

  30. Rouphael C, Shakya S, Arora Z, Gabbard S, Rice T, Lopez R, et al. Esophageal dysmotility and other preoperative factors associated with acid suppressive therapy after fundoplication. Scand J Gastroenterol. 2020;55(1):1–8.

    Article  CAS  Google Scholar 

  31. Siegal SR, Dunst CM, Robinson B, Dewey EN, Swanstrom LL, DeMeester SR. Preoperative High-resolution manometry criteria are associated with dysphagia after Nissen fundoplication. World J Surg. 2019;43(4):1062–7.

    Article  Google Scholar 

  32. Kapadia S, Osler T, Lee A, Borrazzo E. The role of preoperative high resolution manometry in predicting dysphagia after laparoscopic Nissen fundoplication. Surg Endosc. 2018;32(5):2365–72.

    Article  Google Scholar 

  33. Ip S, Tatsioni A, Conant A, Karagozian R, Fu L, Chew P, et al. Predictors of clinical outcomes following fundoplication for gastroesophageal reflux disease remain insufficiently defined: a systematic review. Am J Gastroenterol. 2009;104(3):752–8.

    PubMed  Google Scholar 

  34. Fibbe C, Layer P, Keller J, Strate U, Emmermann A, Zornig C. Esophageal motility in reflux disease before and after fundoplication: a prospective, randomized, clinical, and manometric study. Gastroenterol. 2001;121(1):5–14.

    Article  CAS  Google Scholar 

  35. Herbella FAM, Tedesco P, Nipomnick I, Fiscichella PM, Patti MG. Effect of partial and total laparoscopic fundoplication on esophageal body motility. Surg Endosc. 2007;21(2):285–8.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Fuji City General Hospital, 50, Takashima-cho, Fuji, Shizuoka, 416-0951, Japan

    Kazuto Tsuboi

  2. Department of Surgery, Nishisaitama-Chuo National Hospital, Saitama, Japan

    Nobuo Omura

  3. Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan

    Kazuto Tsuboi, Fumiaki Yano, Nobuo Omura, Masato Hoshino, Se-Ryung Yamamoto, Shunsuke Akimoto, Takahiro Masuda, Yuki Sakashita & Toru Ikegami

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  1. Kazuto Tsuboi
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  2. Fumiaki Yano
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Correspondence to Kazuto Tsuboi.

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Tsuboi, K., Yano, F., Omura, N. et al. Factors affecting the treatment outcomes of laparoscopic fundoplication for erosive reflux esophagitis: findings of esophageal pathological function tests. Surg Today 51, 1568–1576 (2021). https://doi.org/10.1007/s00595-021-02226-4

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