Preoperative physiological esophageal assessment for anti-reflux surgery: A guide for surgeons on high-resolution manometry and pH testing
Open Access
- 28 April 2021
- journal article
- review article
- Published by Baishideng Publishing Group Inc. in World Journal of Gastroenterology
- Vol. 27 (16), 1751-1769
- https://doi.org/10.3748/wjg.v27.i16.1751
Abstract
Gastroesophageal reflux disease (GERD) is one of the most commonly encountered digestive diseases in the world, with the prevalence continuing to increase. Many patients are successfully treated with lifestyle modifications and proton pump inhibitor therapy, but a subset of patients require more aggressive intervention for control of their symptoms. Surgical treatment with fundoplication is a viable option for patients with GERD, as it attempts to improve the integrity of the lower esophageal sphincter (LES). While surgery can be as effective as medical treatment, it can also be associated with side effects such as dysphagia, bloating, and abdominal pain. Therefore, a thorough pre-operative assessment is crucial to select appropriate surgical candidates. Newer technologies are becoming increasingly available to help clinicians identify patients with true LES dysfunction, such as pH-impedance studies and high-resolution manometry (HRM). Pre-operative evaluation should be aimed at confirming the diagnosis of GERD, ruling out any major motility disorders, and selecting appropriate surgical candidates. HRM and pH testing are key tests to consider for patients with GERD like symptoms, and the addition of provocative measures such as straight leg raises and multiple rapid swallows to HRM protocol can assess the presence of underlying hiatal hernias and to test a patient’s peristaltic reserve prior to surgery.Keywords
This publication has 82 references indexed in Scilit:
- Diagnosis and management of patients with reflux symptoms refractory to proton pump inhibitorsGut, 2012
- The value of multiple rapid swallows during preoperative esophageal manometry before laparoscopic antireflux surgerySurgical Endoscopy, 2012
- Effects of Large Hiatal Hernias on Esophageal PeristalsisArchives of Surgery, 2012
- High-Resolution Manometry: An Atlas of Esophageal Motility Disorders and Findings of GERD Using Esophageal Pressure TopographyThoracic Surgery Clinics, 2011
- SAGES guidelines for the surgical treatment of esophageal achalasiaSurgical Endoscopy, 2011
- Apple Sauce Improves Detection of Esophageal Motor Dysfunction During High-Resolution Manometry Evaluation of DysphagiaDigestive Diseases and Sciences, 2010
- Guidelines for surgical treatment of gastroesophageal reflux diseaseSurgical Endoscopy, 2010
- Excessive belching and aerophagia: two different disordersDiseases of the Esophagus, 2010
- The Evolution and Long-Term Results of Laparoscopic Antireflux Surgery for the Treatment of Gastroesophageal Reflux DiseaseJSLS : Journal of the Society of Laparoendoscopic Surgeons, 2010
- Who will fail laparoscopic Nissen fundoplication? Preoperative prediction of long-term outcomesSurgical Endoscopy, 2007