Measurement of outflow resistance imposed by magnetic sphincter augmentation: defining normal values and clinical implic
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and Other Interventional Techniques
2020 SAGES ORAL
Measurement of outflow resistance imposed by magnetic sphincter augmentation: defining normal values and clinical implication Shahin Ayazi1 · Andrew D. Grubic1 · Ping Zheng1 · Ali H. Zaidi1 · Katrin Schwameis1 · Adam C. Alleyne1 · Brittney M. Myers1 · Ashten N. Omstead1 · Blair A. Jobe1 Received: 27 April 2020 / Accepted: 29 September 2020 © The Author(s) 2020
Abstract Introduction No manometric criteria have been defined to select patients for magnetic sphincter augmentation (MSA). The first step to establish such criteria is to measure the outflow resistance at esophagogastric junction (EGJ) imposed by MSA. This resistance needs to be overcome by the esophageal contraction in order for the esophagus to empty and to avoid postoperative dysphagia. This study was designed to measure the outflow resistance caused by MSA in patients free of postoperative dysphagia. Methods Records of the patients who underwent MSA in our institution were reviewed. A group of MSA patients with excellent functional outcome, who were free of clinically significant postoperative dysphagia, were selected. These patients then underwent high-resolution impedance manometry (HRIM) at a target date of 1 year after surgery. The outflow resistance was measured by the esophageal intrabolus pressure (iBP) recorded 2 cm proximal to the lower esophageal sphincter (LES). Results The study population consisted of 43 patients. HRIM was performed at mean of 20.4 (10.4) months after surgery. The mean (SD) amplitude of the iBP was 13.5 (4.3) before surgery and increased to 19.1 (5.6) after MSA (p 15 beads) [19.7 (4.5) vs. 18.4 (5.9), p = 0.35]. There was a significant correlation between the iBP and % incomplete bolus clearance [Spearman R: 0.44 (95% CI 0.15–0.66), p = 0.0032]. The 95th percentile value for iBP after MSA was 30.4 mmHg. Conclusion The EGJ outflow resistance measured by iBP is increased after MSA. The upper limit of normal for iBP is 30 mmHg in this cohort of patients who were free of dysphagia after MSA. This degree of resistance needs to be overcome by distal esophageal contraction and will likely be requisite to prevent persistent postoperative dysphagia. Keywords Magnetic sphincter augmentation (MSA) · High-resolution manometry · Gastroesophageal junction · Dysphagia · Intrabolus pressure (iBP) Magnetic sphincter augmentation (MSA) is a safe and effective surgical treatment for patients with gastroesophageal reflux disease (GERD). This procedure is a technically straightforward and highly reproducible outpatient procedure, and multiple centers across the United States and Europe have reported a high degree of success with This work was selected for podium presentation in the Scientific Session of the SAGES 2020 Annual Meeting, August 12–15, 2020 Cleveland, Ohio. * Shahin Ayazi [email protected] 1
Esophageal Institute, Allegheny Health Network, 4815 Liberty Avenue, Suite 439, Pittsburgh, PA 15224, USA
consistent clinical outcomes [1–3]. MSA is also considered to be a
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