High-resolution manometry findings after Linx procedure for gastro-esophageal reflux disease.

Abstract

Magnetic sphincter augmentation with the Linx® system is a novel laparoscopic procedure for the treatment of gastro-esophageal reflux disease (GERD). Only few data are available regarding the impact of Linx on high-resolution manometry (HRM) variables. The prospectively collected database of patients who underwent Linx procedure at a single institution was queried. All patients who completed pre- and postoperative HRM, GERD health-related quality of life (GERD-HRQL) questionnaire, and functional outcome swallowing scale (FOSS) questionnaire were included in the study. Forty-five out of 304 patients were included. At a median follow-up of 12months (IQR 10) after surgery, a statistically significant increase of lower esophageal sphincter (LES) total length (P=.002), intra-abdominal length (P=.001), integrated relaxation pressure (IRP), intrabolus pressure (IBP), and esophagogastric contractile integral (EGJ-CI) was noted (P<.001). Distal esophageal amplitude (P=.004), mean distal contractile integral (DCI) (P<.001), post multiple repeated swallows DCI (P=.001), and the percent of normal peristalsis increased (P=.040). All patients were relieved of reflux symptoms. Ineffective esophageal motility reversed to normal in 36% of patients after surgery. The only factor significantly associated with postoperative dysphagia was preoperative dysphagia (P=.006). Postoperatively, a significant correlation between IRP and DCI (r=0.361 and P=.019) and between IBP and DCI (r=0.443 and P=.003) was found. The Linx procedure had a remarkable effect on esophageal motility in the short-term follow-up. It appears that the overall postoperative increase of IRP and IBP may justify the higher DCI values. Preoperative dysphagia was the only factor associated with postoperative dysphagia.