Same-day opioid administration in opiate naïve patients is not associated with opioid-induced esophageal dysfunction (OIED).

Abstract

Opioid-induced esophageal dysfunction (OIED) is a recognized complication of chronic opioid use. However, the impact of acute opioid administration on esophageal motility remains unclear. Opioid naïve patients with high-resolution manometry (HRM) <480min following esophagogastroduodenoscopy (EGD) (opioid-HRM) and a control group with HRM <36h prior to EGD between January 1, 2016, and November 10, 2018, from a single institution were identified. EGDs were performed exclusively with versed and fentanyl. One hundred and seventy-four patients were identified, with 83 (47.7%) opioid-HRM and 91 (52.3%) controls. Mean time from EGD to HRM was 229 (78-435)min. Baseline clinical features and HRM indications were similar between opioid-HRM and controls. Chicago classification v3.0 defined HRM findings were similar between groups. Major motility disorders as defined by the Chicago classification v3.0 occurred at a similar frequency among opioid-HRM and controls (27.7% vs. 36.3%, p=0.23). Mean distal contractile integrity (DCI) was higher in opioid-HRM (1939.3±1318.9 vs. 1792.2±2062.3mmHg∙cm∙s, p=0.043), but maximum DCI, distal latency, and integrated relaxation pressure did not differ between groups. Subgroup analysis assessing time and dose dependency did not identify differences in individual manometric parameters and Chicago classification v3.0 diagnosis between patients with HRM <240min after EGD, >240min after EGD, ≥125 mcg of IV fentanyl, <125mcg IV fentanyl and controls. Same-day acute opioid administration did not affect HRM findings in opioid naïve patients. Studies assessing the pathophysiology of and duration-dependent relationship with opioids in OIED are needed.