Preoperative esophageal transit studies are a useful predictor of dysphagia after fundoplication |
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Authors: | Dr David R Hunt MD FRACS Karen A Humphreys MSc Julia Janssen NMSc Erin Mackay MSc Richard Smart PhD |
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Institution: | (1) Upper Gastrointestinal Surgical Unit, St.George Hospital, Kogarah, Sydney, Australia;(2) Department of Nuclear Medicine, St. George Hospital, Kogarah, Sydney, Australia;(3) Level 5, Suite 1, St. George Private Medical Centre, 1 South St., Kogarah, 2217 Sydney, Australia |
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Abstract: | Fundoplication performed for gastroesophageal reflux disease may be complicated by postoperative dysphagia despite successful
reduction in reflux symptoms. This is more likely in those patients with reflux who have concurrent esophageal dysmotility.
The aim of this study was to establish whether esophageal transit studies using a technetium-99m jello bolus (jello esophageal
transit) could detect the presence of motility disorders preoperatively and hence predict surgical outcome. Transit studies
in 33 healthy volunteers yielded a normal range of 2 to 24 seconds using ninety-fifth percentile distribution. In the second
phase of the study, 26 patients accepted for laparoscopic fundoplication were enrolled: jello esophageal transit, manometry,
and endoscopy were attempted preoperatively in all subjects. A clinical dysphagia score was assigned from a questionnaire.
Six months after surgery, five patients had dysphagia and of these four were found to have abnormal preoperative jello esophageal
transit, for a sensitivity of 80%. Of the 21 patients who had no dysphagia after surgery, 20 patients had normal preoperative
jello esophageal transit, showing a specificity of 95%. This esophageal transit study is noninvasive, reliable, and sensitive.
When performed prior to fundoplication, it appears to be of significant value in detecting a subtle functional motility disorder
that predisposes to postoperative dysphagia. Jello esophageal transit may assist the surgeon in planning treatment of gastroesophageal
reflux disease.
Presented at the World Congress of Gastroenterology, Vienna, Austria, September 16, 1998 (poster presentation). |
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Keywords: | Fundoplication dysphagia solid esophageal transit dysmotility |
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