Top

Published in:

15-02-2022 | Gastric Fundoplication | 2021 SAGES Oral

Impedance planimetry (EndoFLIP™) after magnetic sphincter augmentation (LINX®) compared to fundoplication

Authors: Hoover Wu, Mikhail Attaar, Harry J. Wong, Michelle Campbell, Kristine Kuchta, Woody Denham, John Linn, Michael B. Ujiki

Published in: Surgical Endoscopy | Issue 10/2022

Abstract

Introduction

Functional luminal imaging probe (FLIP) use during laparoscopic fundoplication (LF) for gastroesophageal reflux disease is well described. However, there is a lack of data on FLIP measurements during magnetic sphincter augmentation (MSA). This study aims to report our institutional experience in performing FLIP during MSA and to compare these measurements to those obtained during Nissen and Toupet fundoplication.

Methods and procedures

A retrospective review of a prospectively maintained quality database was performed. Patients who underwent MSA or LF and had FLIP measurements between April 2018 and June 2021 were included. FLIP measurements at the gastroesophageal junction (GEJ) were recorded without pneumoperitoneum at 40 mL balloon fill after hernia reduction, cruroplasty, and MSA or fundoplication. Reflux symptom index (RSI), GERD-HRQL, and dysphagia score were collected up to 2 years. Group comparisons were made using two-tailed Wilcoxon rank-sum and χ² tests, with statistical significance of p < 0.05.

Results

Twenty-seven patients underwent MSA and 100 patients underwent LF (66% Toupet, 34% Nissen). Type III hiatal hernia was present in 3.7% of MSA patients versus over 50% for fundoplication patients. Minimum diameter, cross-sectional area, and distensibility index (DI) were lower after MSA device placement compared to Nissen or Toupet fundoplication (p < 0.05). Postoperative follow-up showed no differences in RSI, GERD-HRQL, and dysphagia score between MSA and Nissen fundoplication (p > 0.05).

Conclusion

Intraoperative impedance planimetry provided objective information regarding the geometry of the GEJ during MSA. The ring of magnetic beads restores the anti-reflux barrier and transiently opens with food bolus and belching. The magnetic force of the beads may explain why the DI after MSA is lower yet postoperative quality of life is no different than Nissen fundoplication.

Kwiatek MA, Pandolfino JE, Hirano I, Kahrilas PJ (2010) Esophagogastric junction distensibility assessed with an endoscopic functional luminal imaging probe (EndoFLIP). Gastrointest Endosc 72:272–278. https://doi.org/10.1016/j.gie.2010.01.069CrossRefPubMedPubMedCentral

Turner B, Helm M, Hetzel E, Gould JC (2020) Is that ‘floppy’ fundoplication tight enough? Surg Endosc 34:1823–1828. https://doi.org/10.1007/s00464-019-06947-zCrossRefPubMed

Su B, Novak S, Callahan ZM, Kuchta K, Carbray J, Ujiki MB (2020) Using impedance planimetry (EndoFLIP™) in the operating room to assess gastroesophageal junction distensibility and predict patient outcomes following fundoplication. Surg Endosc 34:1761–1768. https://doi.org/10.1007/s00464-019-06925-5CrossRefPubMed

Ganz RA, Gostout CJ, Grudem J, Swanson W, Berg T, DeMeester TR (2008) Use of a magnetic sphincter for the treatment of GERD: a feasibility study. Gastrointest Endosc 67:287–294. https://doi.org/10.1016/j.gie.2007.07.027CrossRefPubMed

DeMeester TR, Bonavina L, Albertucci M (1986) Nissen fundoplication for gastroesophageal reflux disease. Evaluation of primary repair in 100 consecutive patients. Ann Surg 204:9–20CrossRef

Tian Z, Wang B, Shan C, Zhang W, Jiang D, Qiu M (2015) A meta-analysis of randomized controlled trials to compare long-term outcomes of Nissen and Toupet fundoplication for gastroesophageal reflux disease. PLoS ONE 10:e0127627. https://doi.org/10.1371/journal.pone.0127627CrossRefPubMedPubMedCentral

Lipham JC, Taiganides PA, Louie BE, Ganz RA, DeMeester TR (2015) Safety analysis of first 1000 patients treated with magnetic sphincter augmentation for gastroesophageal reflux disease: magnetic sphincter augmentation for GERD. Dis Esophagus 28:305–311. https://doi.org/10.1111/dote.12199CrossRefPubMed

Skubleny D, Switzer NJ, Dang J, Gill RS, Shi X, de Gara C, Birch DW, Wong C, Hutter MM, Karmali S (2017) LINX® magnetic esophageal sphincter augmentation versus Nissen fundoplication for gastroesophageal reflux disease: a systematic review and meta-analysis. Surg Endosc 31:3078–3084. https://doi.org/10.1007/s00464-016-5370-3CrossRefPubMed

Su B, Callahan ZM, Kuchta K, Linn JG, Haggerty SP, Denham W, Ujiki MB (2020) Use of impedance planimetry (EndoFLIP) in foregut surgery practice: experience of more than 400 cases. J Am Coll Surg 231:160–171. https://doi.org/10.1016/j.jamcollsurg.2020.02.017CrossRefPubMed

10.

Su B, Dunst C, Gould J, Jobe B, Severson P, Newhams K, Sachs A, Ujiki M (2021) Experience-based expert consensus on the intra-operative usage of the EndoFLIP impedance planimetry system. Surg Endosc. https://doi.org/10.1007/s00464-020-07704-3 (Epub ahead of print 16 June 2020)CrossRefPubMed

11.

Su B, Attaar M, Wong H, Callahan ZM, Kuchta K, Stearns S, Linn JG, Denham W, Haggerty SP, Ujiki MB (2021) Using a standardized intra-operative EndoFLIP protocol during fundoplication to identify factors that affect distensibility. Surg Endosc. https://doi.org/10.1007/s00464-020-08034-0 (Epub ahead of print 24 Sep 2020)CrossRefPubMed

12.

Belafsky PC, Postma GN, Koufman JA (2002) Validity and reliability of the reflux symptom index (RSI). J Voice 16:274–277. https://doi.org/10.1016/S0892-1997(02)00097-8CrossRefPubMed

13.

Velanovich V (2007) The development of the GERD-HRQL symptom severity instrument. Dis Esophagus 20:130–134. https://doi.org/10.1111/j.1442-2050.2007.00658.xCrossRefPubMed

14.

Chrysos E, Tsiaoussis J, Zoras OJ, Athanasakis E, Mantides A, Katsamouris A, Xynos E (2003) Laparoscopic surgery for gastroesophageal reflux disease patients with impaired esophageal peristalsis: total or partial fundoplication? J Am Coll Surg 197:8–15. https://doi.org/10.1016/S1072-7515(03)00151-0CrossRefPubMed

15.

Strate U, Emmermann A, Fibbe C, Layer P, Zornig C (2008) Laparoscopic fundoplication: Nissen versus Toupet two-year outcome of a prospective randomized study of 200 patients regarding preoperative esophageal motility. Surg Endosc 22:21–30. https://doi.org/10.1007/s00464-007-9546-8CrossRefPubMed

16.

Shaw JM, Bornman PC, Callanan MD, Beckingham IJ, Metz DC (2010) Long-term outcome of laparoscopic Nissen and laparoscopic Toupet fundoplication for gastroesophageal reflux disease: a prospective, randomized trial. Surg Endosc 24:924–932. https://doi.org/10.1007/s00464-009-0700-3CrossRefPubMed

17.

Broeders JAJL, Mauritz FA, Ahmed Ali U, Draaisma WA, Ruurda JP, Gooszen HG, Smout AJPM, Broeders IAMJ, Hazebroek EJ (2010) Systematic review and meta-analysis of laparoscopic Nissen (posterior total) versus Toupet (posterior partial) fundoplication for gastro-oesophageal reflux disease. Br J Surg 97:1318–1330. https://doi.org/10.1002/bjs.7174CrossRefPubMed

18.

Koch OO, Kaindlstorfer A, Antoniou SA, Luketina RR, Emmanuel K, Pointner R (2013) Comparison of results from a randomized trial 1 year after laparoscopic Nissen and Toupet fundoplications. Surg Endosc 27:2383–2390. https://doi.org/10.1007/s00464-013-2803-0CrossRefPubMed

19.

Ayazi S, Chowdhury N, Zaidi AH, Chovanec K, Komatsu Y, Omstead AN, Zheng P, Hoppo T, Jobe BA (2020) Magnetic sphincter augmentation (MSA) in patients with hiatal hernia: clinical outcome and patterns of recurrence. Surg Endosc 34:1835–1846. https://doi.org/10.1007/s00464-019-06950-4CrossRefPubMed

20.

Yadlapati R, Hungness ES, Pandolfino JE (2018) Complications of antireflux surgery. Am J Gastroenterol 113:1137–1147. https://doi.org/10.1038/s41395-018-0115-7CrossRefPubMedPubMedCentral

21.

Broeders JAJL, Bredenoord AJ, Hazebroek EJ, Broeders IAMJ, Gooszen HG, Smout AJPM (2011) Effects of anti-reflux surgery on weakly acidic reflux and belching. Gut 60:435–441. https://doi.org/10.1136/gut.2010.224824CrossRefPubMed

22.

Wilshire CL, Niebisch S, Watson TJ, Litle VR, Peyre CG, Jones CE, Peters JH (2012) Dysphagia postfundoplication: more commonly hiatal outflow resistance than poor esophageal body motility. Surgery 152:584–594. https://doi.org/10.1016/j.surg.2012.07.014CrossRefPubMed

Title: Impedance planimetry (EndoFLIP™) after magnetic sphincter augmentation (LINX®) compared to fundoplication
Authors: Hoover Wu
Mikhail Attaar
Harry J. Wong
Michelle Campbell
Kristine Kuchta
Woody Denham
John Linn
Michael B. Ujiki
Publication date: 15-02-2022
Publisher: Springer US
Keywords: Gastric Fundoplication
Gastric Fundoplication
Dysphagia
Dysphagia
Dysphagia
Published in: Surgical Endoscopy / Issue 10/2022
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-022-09128-7

At a glance: The STEP trials

Springer Medicine

Impedance planimetry (EndoFLIP™) after magnetic sphincter augmentation (LINX®) compared to fundoplication

Abstract

Introduction

Methods and procedures

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods and procedures

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 10/2022

Feasibility of pressurized intra peritoneal aerosol chemotherapy using an ultrasound aerosol generator (usPIPAC)

Social support provided to bariatric surgery patients through a facebook group may improve weight loss outcomes

Safety of laparoscopic surgery during pregnancy: a Korean nationwide population-based study

Effect of intravenous scopolamine before stapling, on postoperative nausea and vomiting in sleeve gastrectomy patients: a randomized controlled trial

Robot-assisted minimally invasive esophagectomy (RAMIE) vs. hybrid minimally invasive esophagectomy: propensity score matched short-term outcome analysis of a European high-volume center

Prevention of incisional hernia after single-port sleeve gastrectomy (PRISM): a prospective non-randomized controlled study