Robert Roether, Amy Banks-Venegoni, MD, Brittany Kern, MD, David Scheeres, MD. Spectrum Health/Michigan State University
Background: Practice patterns amongst surgeons in the preoperative evaluation of Gastro-Esophageal Reflux Disease (GERD) and the type of anti-reflux fundoplication procedures performed vary widely. The Esophageal Diagnostic Advisory Panel recommends tailoring the type of anti-reflux fundoplication based on findings of the esophageal peristaltic wave and degree of esophageal dysmotility. High resolution manometry (HRM) is the gold standard for diagnosing esophageal dysmotility. Many surgeons, however, only use a barium esophagram (BE) to identify the presence of esophageal dysmotility and use its diagnostic findings to guide the type of fundoplication performed.
Aim: To determine if barium esophagram alone is sufficient to diagnose esophageal dysmotility when compared to high resolution manometry.
Methods: This is a retrospective review of patients that underwent a laparoscopic full or partial fundoplication by a single surgeon from 10/1/2015 to 7/1/2018. All HRM reports were blinded and read by an independent surgeon with an inter-rater reliability of 100%.
Results: There were 65 patients total, 30 patients had both BE and HRM studies to make a comparison. None of the 30 patients (0%) had dysmotility identified on both manometry and BE. Ten of 30 (33.3%) had dysmotility identified on HRM without identification on BE. Five of 30 (16.7%) had dysmotility on BE, but no dysmotility on HRM. Half of the patients had negative findings for dysmotility on HRM and BE. Utilizing HRM as the gold standard, BE had a Sensitivity of 0% (CI 0% – 27.8%), Specificity of 75% (CI 53.1% – 88.8%), Positive Predictive Value of 0% (CI 0% – 43.4%), and Negative Predictive Value of 60% (CI 40.7% – 76.6%). The accuracy of BE was 50%.
Conclusion: The data from this pilot study demonstrate that barium esophagram is not an effective diagnostic tool to determine if esophageal dysmotility is present. Implications of the results suggest that surgical decision making should not be based on barium esophagram alone, which has a PPV of 0% and accuracy of 50%, and should be reinforced by acquisition of high resolution manometry.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94456
Program Number: P462
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster