Evan T Alicuben, MD, Nikolai Bildzukewicz, MD, Kamran Samakar, MD, Namir Katkhouda, MD, Adrian Dobrowolsky, MD, Kulmeet Sandhu, MD, John C Lipham, MD. University of Southern California
Introduction: Videoesophagram (VEG) and esophageal manometry (EM) are components of the preoperative evaluation for foregut surgery. EM is able to identify significant motility disorders and diminished contractility that may alter the choice of an anti-reflux procedure. However, there are no clearly defined criteria to guide this selection. Furthermore, preoperative EM has not been shown to predict postoperative dysphagia. EM is not always easily and reliably obtained, and therefore its necessity in routine preoperative evaluation is unclear.
Hypothesis: If a patient has normal videoesophagram, EM does not reveal severe esophageal dysfunction or major disorders of peristalsis.
Methods and Procedures: We retrospectively reviewed all patients who underwent high resolution esophageal manometry and videoesophagram. EM and VEG were performed according to protocol. Accepted measures of esophageal motility including the mean distal contractile integral (DCI), mean wave amplitude (MWA), and percent of peristaltic swallows (PPS) were analyzed. The Chicago Classification was used for diagnostic criteria of major disorders. DCI less than 450 mm Hg·s·cm, MWA less than 30 mm Hg, and PPS less than or equal to 50 were considered abnormal. Normal VEG was defined as stasis of liquid barium in the distal third of the esophagus on less than three of five swallows.
Results: There were 419 patients in the study. 231 patients (55%) had a normal VEG and 188 patients (45%) had an abnormal VEG. In the normal VEG group, only 2/231 (0.9%) patients were identified as having both abnormal DCI and PPS.
| PPS ≤50% | >50% | |
| DCI <450 | 2 | 17 |
| ≥450 | 11 | 201 |
There were no patients with both abnormal MWA and PPS.
| PPS ≤50% | >50% | |
| MWA <30 | 0 | 3 |
| ≥30 | 13 | 215 |
There were no patients identified with achalasia or absent contractility. There were 8 patients with criteria for hypercontractile esophagus and 2 patients for ineffective esophageal motility (IEM). This was in contrast to the abnormal VEG group where 4 patients with achalasia, 17 patients with hypercontractile esophagus and 15 patients with IEM were identified.
Conclusions: Routine esophageal manometry did not identify significant esophageal dysfunction or major motility disorders in patients with a normal VEG. EM is not warranted in patients with normal videoesophagram, and should be reserved for patients with abnormal VEG.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86844
Program Number: S096
Presentation Session: Foregut/Gastric Session
Presentation Type: Podium