OGBN P36 Surgical Consideration in Patients with Ineffective Oesophagus: Implications for Low Risk of Dysphagia and Suitability for Antireflux Operation

Abstract

Abstract Background Ineffective oesophageal motility (IOM) is a minor motility disorder that is commonly found in patients. The IOM diagnosis is based on heterogenous combination of failed peristalsis, weak peristalsis activity and peristaltic defects that are observed during the stimulation to 5mL standard water swallows. IOM is implicated to post-surgical dysphagia and therefore influences the surgical decision making. This paper will address this topic. Methods A retrospective review was conducted on patients who underwent oesophageal high-resolution manometry (HRM) between March and May 2023. The diagnosis of IOM was based on the international Chicago Classification guideline (version 4.0). Patients' oesophageal motility profiles were assessed for peristaltic reservation (PR) and oesophageal contractile mean wave amplitude (MWA). PR >100% in IOM patients indicates low risk of dysphagia after laparoscopic Nissen fundoplication (LNF). Similarly, normal MWA indicate a low risk of dysphagia in considering patients for Magnetic Sphincter Augmentation (MSA). Results 120/270 patients (44.4%) were diagnosed with IOM (female:male=86:34, median age 52 years old). Mean PR in IOM patients was 217.8% [95%CI:181.2%-254.4%] with 60.8% demonstrating PR >100%. Average MWA found in IOM patients was 40.8mmHg (95%CI:38.5mmHg-43.1mmHg) with 38.3% demonstrating normal MWA. 13.3% (16/120) of patients did not invoke peristalsis on MWS, but 6 of the 16 patients showed normal MWA. 24.2% (29/120) patients demonstrated PR >100% and normal MWA. 14.2% (17/120) of patients showed adequate PR and weak MWA and pose risk of postsurgical dysphagia. 75% (90/120) of patients with IOM were suitable for at least one antireflux operation. Conclusions Approximately half of the oesophageal physiology patients have IOM and three-quarters of these patients are suitable for at least one form surgical intervention with low risk postsurgical dysphagia. Only 14.2% of patients with IOM pose a risk of post-surgical dysphagia. The overall findings suggests that surgical intervention may be a viable option for patients with IOM that could potentially improve their quality of life and prevent reflux oesophagitis/pre-cancerous Barrett’s oesophagus. This study was limited by not investigating the relationship between IOM pathophysiology and the reflux oesophagitis severity grade.