Rodrigo Pedraza, MD, Edward Y Chan, Ray K Chihara, MD, PhD, Leonora M Meisenbach, MSN, APRN, ACNPBC, Min P Kim. Houston Methodist Hospital
Background: Magnetic sphincter augmentation device (LINX) placement has been demonstrated to provide optimal mid-term outcomes for the management of gastroesophageal reflux disease (GERD). However, dysphagia following LINX placement has been reported as frequently as 83%. The endoluminal functional luminal-imaging probe (EndoFLIP®) provides an objective functional distensibility assessment of the GEJ. We aimed to investigate clinical outcomes following LINX placement while using intraoperative EndoFLIP®.
Methods: The data were obtained from a prospectively maintained database. From 5/2017 to 2/2018, all patients who underwent LINX placement with the use of intraoperative EndoFLIP were included in our study. During the procedure, the EndoFLIP is placed and inflated after circumferential esophageal mobilization. The EndoFLIP values at baseline, following crural closure, and after LINX placement were recorded and compared. Modification was performed during the operation so that the final EndoFLIP value is >0.5 with 30 cc of fluid in the balloon.
Results: A total of 30 patients were evaluated. The average age of patients was 54 with 83% females, a median ASA of 2 and an average BMI of 30.5. There were 43% of patients with type III hiatal hernia and 57% had type I hiatal hernia and 23% underwent redo-hiatal hernia repair. The peristalsis was >70% for all patients on manometry and the mean preoperative DeMeester score was 34. All patients underwent robot-assisted hiatal hernia repair with LINX and the median LINX size was 16 (14-17). There was no intraoperative and immediate postoperative complications or 30-day readmissions, and the median LOS was 1 (0-3). The pre-intervention EGJ distensibility index on EndoFLIP was 2.9 as compared to postoperative 1.5, p<0.0001. The mean preoperative GERD QOL was 24 as compared with postoperative 5.5, p<0.0001. There was no significant difference of average dysphagia score (1-5 scale) between prior to surgery (2.2 +/- 0.33) and after the surgery (1.4 +/- 0.26, p=0.058). One patient had a dysphagia score of 5 after surgery but further work-up showed an esophageal spasm as the cause and the symptoms resolved with muscle relaxant administration. None of the patients needed steroids for treatment of post LINX dysphagia.
Conclusions: Our study showed that the use of EndoFLIP for intraoperative EGJ distensibility assessment during LINX placement could help prevent significant dysphagia after surgery. The use of EndoFLIP may provide an objective metric to predict successful functional GEJ following LINX placement.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94247
Program Number: P529
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster
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