Timothy W Mansour, MD, William O Richards, MD. University of South Alabama
Esophagogastric Junction Outflow Obstruction (EGJOO) is a variant of achalasia that is characterized by increased lower esophageal sphincter (LES) tone in the setting of preserved peristalsis. It is a relatively new diagnosis since the advent of high resolution manometry (HRM) and its management has not been well studied. Heller Myotomy and Dor Fundoplication has been shown to be an excellent treatment for achalasia, but its use in EGJOO is uncertain. We present our experience with six patients who have received this operation for EGJOO. The primary presenting complaints of patients with manometric diagnosis of EGJOO are reflux (6/6 patients) and dysphagia (5/6). They all completed the Gastroesophageal Reflux Disease Health Related Quality of Life (GERD-HRQL) tool to quantify the severity of their symptoms both pre- and post-operatively. All of the patients who received the operation, had a marked improvement in reflux symptoms with a decrease from an average pre-operative GERD-HRQL score of 39 to an average post-operative score of 15.5. Four out of the five patients with dysphagia had complete resolution of dysphagia symptoms, with one patient reporting minimal change in dysphagia symptoms. Interestingly, the patient who reported minimal improvement had post-operative manometry that showed resolution of the EGJOO (normal peristalsis and IRP on the post-operative study). Four of the six patients studied reported complete satisfaction with the symptom improvement that the procedure provided. The other two patients (one neutral, one dissatisfied) both presented with very high pre-operative GERD-HRQL scores (average 47.5) and still had bothersome reflux symptoms (average GERD-HRQL 34) despite improvement in dysphagia. None of the patients in this series experienced post-operative complications. While EGJOO remains a poorly understood disease entity, Heller Myotomy and Dor Fundoplication seems to be an effective treatment for patients who present with dysphagia and reflux symptoms.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95643
Program Number: P483
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster