Skip to main content
SpringerLink
Log in

Post-operative HRIM and FLIP for Dysphagia Following Antireflux Procedures

  • Chapter
  • First Online:
Hiatal Hernia Surgery

  • 1020 Accesses

Abstract

Post-operative dysphagia after an antireflux procedure is a common problem that requires a thorough evaluation of anatomy and physiology to determine whether the complaint is due to obstruction at the esophagogastric junction or a defect in peristalsis that was either missed or underestimated during the pre-operative assessment. Many tools are helpful in this assessment and the first step is to assess the anatomy of the EGJ as antireflux procedures focus primarily on attempting to augment the barrier function of this anatomic zone. This can be accomplished with a careful endoscopy or a barium esophagram to determine whether the antireflux procedure is intact or potentially disrupted with or without herniation. Additionally, these tools are also important in ruling out strictures and other mechanical problems related to the various endoscopic and surgical approaches.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Pandolfino JE, Kahrilas PJ, American GA. American Gastroenterological Association medical position statement: clinical use of esophageal manometry. Gastroenterology. 2005;128(1):207–8.

    Article  PubMed  Google Scholar 

  2. Clouse RE, Staiano A. Topography of the esophageal peristaltic pressure wave. Am J Phys. 1991;261(4 Pt 1):G677–84.

    CAS  Google Scholar 

  3. Pandolfino JE, Ghosh SK, Rice J, et al. Classifying esophageal motility by pressure topography characteristics: a study of 400 patients and 75 controls. Am J Gastroenterol. 2008;103(1):27–37.

    Article  PubMed  Google Scholar 

  4. Kahrilas PJ, Bredenoord AJ, Fox M, et al. The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27(2):160–74.

    Article  CAS  PubMed  Google Scholar 

  5. Weijenborg PW, Savarino E, Kessing BF, et al. Normal values of esophageal motility after antireflux surgery; a study using high-resolution manometry. Neurogastroenterol Motil. 2015;27(7):929–35.

    Article  CAS  PubMed  Google Scholar 

  6. Wilshire CL, Niebisch S, Watson TJ, et al. Dysphagia postfundoplication: more commonly hiatal outflow resistance than poor esophageal body motility. Surgery. 2012;152(4):584–92. discussion 92-4

    Article  PubMed  Google Scholar 

  7. Xiao Y, Read A, Nicodeme F, et al. The effect of a sitting vs supine posture on normative esophageal pressure topography metrics and Chicago classification diagnosis of esophageal motility disorders. Neurogastroenterol Motil. 2012;24(10):e509–16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Sweis R, Anggiansah A, Wong T, et al. Normative values and inter-observer agreement for liquid and solid bolus swallows in upright and supine positions as assessed by esophageal high-resolution manometry. Neurogastroenterol Motil. 2011;23(6):509–e198.

    Article  CAS  PubMed  Google Scholar 

  9. Fornari F, Bravi I, Penagini R, et al. Multiple rapid swallowing: a complementary test during standard oesophageal manometry. Neurogastroenterol Motil. 2009;21(7):718–e41.

    Article  CAS  PubMed  Google Scholar 

  10. Shaker A, Stoikes N, Drapekin J, et al. Multiple rapid swallow responses during esophageal high-resolution manometry reflect esophageal body peristaltic reserve. Am J Gastroenterol. 2013;108(11):1706–12.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Herregods TV, Roman S, Kahrilas PJ, et al. Normative values in esophageal high-resolution manometry. Neurogastroenterol Motil. 2015;27(2):175–87.

    Article  CAS  PubMed  Google Scholar 

  12. Pandolfino JE, Bianchi LK, Lee TJ, et al. Esophagogastric junction morphology predicts susceptibility to exercise-induced reflux. Am J Gastroenterol. 2004;99(8):1430–6.

    Article  PubMed  Google Scholar 

  13. Pandolfino JE, Ghosh SK, Zhang Q, et al. Quantifying EGJ morphology and relaxation with high-resolution manometry: a study of 75 asymptomatic volunteers. Am J Physiol Gastrointest Liver Physiol. 2006;290(5):G1033–40.

    Article  CAS  PubMed  Google Scholar 

  14. Pandolfino JE, Leslie E, Luger D, et al. The contractile deceleration point: an important physiologic landmark on oesophageal pressure topography. Neurogastroenterol Motil. 2010;22(4):395–400. e90

    Article  CAS  PubMed  Google Scholar 

  15. Roman S, Lin Z, Pandolfino JE, et al. Distal contraction latency: a measure of propagation velocity optimized for esophageal pressure topography studies. Am J Gastroenterol. 2011;106(3):443–51.

    Article  PubMed  Google Scholar 

  16. Xiao Y, Kahrilas PJ, Kwasny MJ, et al. High-resolution manometry correlates of ineffective esophageal motility. Am J Gastroenterol. 2012;107(11):1647–54.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Hong SJ, Bhargava V, Jiang Y, et al. A unique esophageal motor pattern that involves longitudinal muscles is responsible for emptying in achalasia esophagus. Gastroenterology. 2010;139(1):102–11.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lin Z, Imam H, Nicodeme F, et al. Flow time through esophagogastric junction derived during high-resolution impedance-manometry studies: a novel parameter for assessing esophageal bolus transit. Am J Physiol Gastrointest Liver Physiol. 2014;307(2):G158–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Lin Z, Carlson DA, Dykstra K, et al. High-resolution impedance manometry measurement of bolus flow time in achalasia and its correlation with dysphagia. Neurogastroenterol Motil. 2015;27(9):1232–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Lin Z, Nicodeme F, Lin CY, et al. Parameters for quantifying bolus retention with high-resolution impedance manometry. Neurogastroenterol Motil. 2014;26(7):929–36.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Omari TI, Wauters L, Rommel N, et al. Oesophageal pressure-flow metrics in relation to bolus volume, bolus consistency, and bolus perception. United European Gastroenterol J. 2013;1(4):249–58.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Pandolfino JE, Shi G, Trueworthy B, et al. Esophagogastric junction opening during relaxation distinguishes nonhernia reflux patients, hernia patients, and normal subjects. Gastroenterology. 2003;125(4):1018–24.

    Article  PubMed  Google Scholar 

  23. Rao SS, Hayek B, Summers RW. Impedance planimetry: an integrated approach for assessing sensory, active, and passive biomechanical properties of the human esophagus. Am J Gastroenterol. 1995;90(3):431–8.

    CAS  PubMed  Google Scholar 

  24. McMahon BP, Frokjaer JB, Drewes AM, et al. A new measurement of oesophago-gastric junction competence. Neurogastroenterol Motil. 2004;16(5):543–6.

    Article  CAS  PubMed  Google Scholar 

  25. McMahon BP, Frokjaer JB, Liao D, et al. A new technique for evaluating sphincter function in visceral organs: application of the functional lumen imaging probe (FLIP) for the evaluation of the oesophago-gastric junction. Physiol Meas. 2005;26(5):823–36.

    Article  CAS  PubMed  Google Scholar 

  26. Hirano I, Pandolfino JE, Boeckxstaens GE. Functional lumen imaging probe for the management of esophageal disorders: expert review from the clinical practice updates committee of the AGA Institute. Clin Gastroenterol Hepatol. 2017;15(3):325–34.

    Article  PubMed  Google Scholar 

  27. Kwiatek MA, Pandolfino JE, Hirano I, et al. Esophagogastric junction distensibility assessed with an endoscopic functional luminal imaging probe (EndoFLIP). Gastrointest Endosc. 2010;72(2):272–8.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Rohof WO, Hirsch DP, Kessing BF, et al. Efficacy of treatment for patients with achalasia depends on the distensibility of the esophagogastric junction. Gastroenterology. 2012;143(2):328–35.

    Article  PubMed  Google Scholar 

  29. Verlaan T, Rohof WO, Bredenoord AJ, et al. Effect of peroral endoscopic myotomy on esophagogastric junction physiology in patients with achalasia. Gastrointest Endosc. 2013;78(1):39–44.

    Article  PubMed  Google Scholar 

  30. Tucker E, Sweis R, Anggiansah A, et al. Measurement of esophago-gastric junction cross-sectional area and distensibility by an endolumenal functional lumen imaging probe for the diagnosis of gastro-esophageal reflux disease. Neurogastroenterol Motil. 2013;25(11):904–10.

    Article  CAS  PubMed  Google Scholar 

  31. Mikami H, Ishimura N, Fukazawa K, et al. Effects of metoclopramide on Esophageal motor activity and Esophagogastric junction compliance in healthy volunteers. J Neurogastroenterol Motil. 2016;22(1):112–7.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Pandolfino JE, de Ruigh A, Nicodeme F, et al. Distensibility of the esophagogastric junction assessed with the functional lumen imaging probe (FLIP) in achalasia patients. Neurogastroenterol Motil. 2013;25(6):496–501.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Rieder E, Swanstrom LL, Perretta S, et al. Intraoperative assessment of esophagogastric junction distensibility during per oral endoscopic myotomy (POEM) for esophageal motility disorders. Surg Endosc. 2013;27(2):400–5.

    Article  PubMed  Google Scholar 

  34. Carlson DA, Lin Z, Kahrilas PJ, et al. The functional lumen imaging probe detects Esophageal contractility not observed with manometry in patients with achalasia. Gastroenterology. 2015;149(7):1742–51.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This work was supported by T32 DK101363 (JEP) and R01 DK079992 (JEP) from the Public Health service.

Disclosures: John E. Pandolfino: Given Imaging/Medtronic (Consultant, Grant, Speaking), Sandhill Scientific (Consulting, Speaking), Takeda (Speaking), Astra Zeneca (Speaking), Torax (Speaking, Consulting), Impleo (Consultant).

Dustin A. Carlson: none.

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, 676 St Clair St, Suite 1400, Chicago, IL, 60611-2951, USA

    John Pandolfino & Dustin Carlson

Authors
  1. John Pandolfino
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dustin Carlson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John Pandolfino .

Editor information

Editors and Affiliations

  1. Faculty of Health Sciences and Medicine, University of Southern Queensland Faculty of Health Sciences and Medicine, Toowoomba, Queensland, Australia

    Muhammed Ashraf Memon

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Pandolfino, J., Carlson, D. (2018). Post-operative HRIM and FLIP for Dysphagia Following Antireflux Procedures. In: Memon, M. (eds) Hiatal Hernia Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-64003-7_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-64003-7_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-64002-0

  • Online ISBN: 978-3-319-64003-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation