Upper Gastrointestinal Contrast Study in the Preoperative Evaluation for Fundoplication Procedures: Does It Make an y Difference?

Mazen R Al-Mansour, MD, Jay J Guan, BS, Kaitlyn Wong, MD, Saiqa I Khan, MD, Paul F Visintainer, PhD, Alexander Knee, MS, David B Earle, MD, FACS

Baystate Medical Center

INTRODUCTION: Esophageal manometry (EM) is considered by many as the gold standard preoperative tool to evaluate esophageal motility prior to fundoplication procedures. We hypothesize that a proper upper gastrointestinal contrast study (UGI) is an essential tool in the preoperative evaluation of these patients. UGI may provide more information than EM, and is at least as important for adequate preoperative assessment and surgical decision-making

METHODS AND PROCEDURES: We retrospectively reviewed 109 adult patients that underwent laparoscopic fundoplication procedures for the treatment of gastroesophageal reflux disease and paraesophageal hernia in the period between March 2009 and December 2012 at a single institution. We excluded patients with redo fundoplication, paraesophageal hernia repair in the setting of other gastroesophageal operations and acute gastric volvulus. All subjects had a high-resolution EM and/or UGI performed preoperatively. The Kappa statistics (κ) and McNemar’s exact test were used to evaluate agreement and disagreement among subjects who had both EM and UGI.

RESULTS: The mean age was 61 years, 79.8% were female, and mean BMI was 30. EM was poorly tolerated in 15% of patients when attempted (7/48), and UGI was performed in 102 subjects. 35 patients had both EM and UGI performed, where esophageal motility was described for liquids and/or solids on UGI (Table 1). Agreement between EM and UGI was low (κ=0.06). McNemar’s exact test was significant (p=0.049) suggesting differences between EM and UGI. Of all 23 abnormal findings, 4 (17%) were discovered by UGI alone.

CONCLUSIONS: A proper UGI provides anatomic information, and information regarding liquid and solid bolus transport that EM alone would not yield. While both EM and UGI assess esophageal motility, significant disagreement exists between the two tests. Both tests are thus complimentary, and they should both be obtained when feasible. EM is often poorly tolerated, and is often difficult to perform in the presence of a paraesophageal hernia. A UGI should be strongly considered in this setting.

Session: Poster Presentation

Program Number: P250