High‐resolution manometry findings after Linx procedure for gastro‐esophageal reflux disease. Issue 3 (21st October 2019)

• Record Type: Journal Article
• Authors: Riva, Carlo Galdino; Siboni, Stefano; Sozzi, Marco; Lazzari, Veronica; Asti, Emanuele; Bonavina, Luigi
• Is Part Of: Neurogastroenterology & motility. Volume 32:Issue 3(2020)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2019-10-21
• Subjects: dysphagia -- gastro‐esophageal reflux disease -- high‐resolution manometry -- laparoscopic surgery -- linx procedure -- magnetic sphincter augmentation; Gastrointestinal system -- Motility -- Periodicals; Gastrointestinal system -- Innervation -- Periodicals; 616.33
• DOI: 10.1111/nmo.13750
• Languages: English
• ISSNs: 1350-1925

Abstract

Abstract: Background: 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. Methods: 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. Key Results: Forty‐five out of 304 patients were included. At a median follow‐up of 12 months (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. Conclusions and Inferences: 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. Abstract : After a sphincter augmentation procedure (Linx), a significant reduction in the incidence of GERD symptoms was noted. Postoperatively, ineffective esophageal motility reversed to normal in 36% of patients, and a significant correlation between IRP and DCI was found. Baseline dysphagia was the only factor significantly associated with postoperative dysphagia.