Top

Published in:

01-03-2020 | Obesity

Hiatal hernia diagnosis prospectively assessed in obese patients before bariatric surgery: accuracy of high-resolution manometry taking intraoperative diagnosis as reference standard

Authors: Antonella Santonicola, Luigi Angrisani, Antonio Vitiello, Salvatore Tolone, Nigel John Trudgill, Carolina Ciacci, Paola Iovino

Published in: Surgical Endoscopy | Issue 3/2020

Abstract

Background

Hiatal hernia (HH) is common in obese patients undergoing bariatric surgery. Preoperative traditional techniques such as upper gastrointestinal endoscopy (UGIE) or barium swallow/esophagram do not always correlate with intraoperative findings. High-resolution manometry (HRM) has shown a higher sensitivity and specificity than traditional techniques in non-obese patients in the HH diagnosis, whereas there is a lack of data in the morbidly obese population. We aimed to prospectively assess the diagnostic accuracy of HRM in HH detection, in comparison with barium swallow and UGIE, assuming intraoperative diagnosis as a standard of reference.

Methods

Forty-one consecutive morbidly obese patients prospectively recruited from a tertiary-care referral hospital devoted to bariatric and metabolic surgery underwent a preoperative evaluation including standardized GERD questionnaires, barium swallow, UGIE, and HRM. The surgical procedures were performed by a single surgeon who was blinded to the results of other investigations.

Results

HH was intraoperatively diagnosed in 11/41 patients (26.8%). In 10/11 patients, the preoperative HRM showed an esophagogastric junction suggestive of HH. When compared to intraoperative evaluation, the sensitivity of the HRM was 90.9% and the specificity 63.3%, with a positive predictive value of 47.6% and a negative predictive value of 95.0%. HRM showed a higher sensitivity and specificity compared to barium swallow and UGIE.

Conclusions

HRM has a high accuracy of HH detection in morbidly obese patients assuming an intraoperative diagnosis as reference standard. It could therefore be a very useful tool in the preoperative work-up of obese patients undergoing bariatric surgery.

Wilson LJ, Ma W, Hirschowitz BI (1999) Association of obesity with hiatal hernia and esophagitis. Am J Gastroenterol 94(10):2840–2844. https://doi.org/10.1111/j.1572-0241.1999.01426.x CrossRefPubMed

El-Serag HB, Graham DY, Satia JA, Rabeneck L (2005) Obesity is an independent risk factor for GERD symptoms and erosive esophagitis. Am J Gastroenterol 100(6):1243–1250. https://doi.org/10.1111/j.1572-0241.2005.41703.x CrossRefPubMed

ASMBS Clinical Issues Committee (2010) Updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis 6(1):1–5. https://doi.org/10.1016/j.soard.2009.11.004 CrossRef

Carabotti M, Silecchia G, Greco F, Leonetti F, Piretta L, Rengo M, Rizzello M, Osborn J, Corazziari E, Severi C (2013) Impact of laparoscopic sleeve gastrectomy on upper gastrointestinal symptoms. Obes Surg 23(10):1551–1557. https://doi.org/10.1007/s11695-013-0973-4 CrossRefPubMed

Hyun JJ, Bak YT (2011) Clinical significance of hiatal hernia. Gut Liver 5(3):267–277. https://doi.org/10.5009/gnl.2011.5.3.267 CrossRefPubMedPubMedCentral

Ott DJ, Gelfand DW, Chen YM, Wu WC, Munitz HA (1985) Predictive relationship of hiatal hernia to reflux esophagitis. Gastrointest Radiol 10(4):317–320CrossRef

Patti MG, Goldberg HI, Arcerito M, Bortolasi L, Tong J, Way LW (1996) Hiatal hernia size affects lower esophageal sphincter function, esophageal acid exposure, and the degree of mucosal injury. Am J Surg 171(1):182–186. https://doi.org/10.1016/s0002-9610(99)80096-8 CrossRefPubMed

Weijenborg PW, van Hoeij FB, Smout AJ, Bredenoord AJ (2015) Accuracy of hiatal hernia detection with esophageal high-resolution manometry. Neurogastroenterol Motil 27(2):293–299. https://doi.org/10.1111/nmo.12507 CrossRefPubMed

Sadowski DC, Broenink L (2008) High-resolution esophageal manometry: a time motion study. Can J Gastroenterol 22(4):365–368CrossRef

10.

Goitein D, Sakran N, Rayman S, Szold A, Goitein O, Raziel A (2017) Barium swallow for hiatal hernia detection is unnecessary prior to primary sleeve gastrectomy. Surg Obes Relat Dis 13(2):138–142. https://doi.org/10.1016/j.soard.2016.08.006 CrossRefPubMed

11.

Mohammed R, Fei P, Phu J, Asai M, Antanavicius G (2017) Efficiency of preoperative esophagogastroduodenoscopy in identifying operable hiatal hernia for bariatric surgery patients. Surg Obes Relat Dis 13(2):287–290. https://doi.org/10.1016/j.soard.2016.08.015 CrossRefPubMed

12.

Khajanchee YS, Cassera MA, Swanstrom LL, Dunst CM (2013) Diagnosis of type-I hiatal hernia: a comparison of high-resolution manometry and endoscopy. Dis Esophagus 26(1):1–6. https://doi.org/10.1111/j.1442-2050.2011.01314.x CrossRefPubMed

13.

Linke GR, Borovicka J, Schneider P, Zerz A, Warschkow R, Lange J, Muller-Stich BP (2008) Is a barium swallow complementary to endoscopy essential in the preoperative assessment of laparoscopic antireflux and hiatal hernia surgery? Surg Endosc 22(1):96–100. https://doi.org/10.1007/s00464-007-9379-5 CrossRefPubMed

14.

Heacock L, Parikh M, Jain R, Balthazar E, Hindman N (2012) Improving the diagnostic accuracy of hiatal hernia in patients undergoing bariatric surgery. Obes Surg 22(11):1730–1733. https://doi.org/10.1007/s11695-012-0721-1 CrossRefPubMed

15.

The Helsinki Declaration of the World Medical Association (WMA) (2014) Ethical principles of medical research involving human subjects. Polski merkuriusz lekarski organ Polskiego Towarzystwa Lekarskiego 36(215):298–301

16.

Amato G, Limongelli P, Pascariello A, Rossetti G, Del Genio G, Del Genio A, Iovino P (2008) Association between persistent symptoms and long-term quality of life after laparoscopic total fundoplication. Am J Surg 196(4):582–586. https://doi.org/10.1016/j.amjsurg.2007.09.038 CrossRefPubMed

17.

Iovino P, Ciacci C, Sabbatini F, Acioli DM, D’Argenio G, Mazzacca G (1998) Esophageal impairment in adult celiac disease with steatorrhea. Am J Gastroenterol 93(8):1243–1249. https://doi.org/10.1111/j.1572-0241.1998.00403.x CrossRefPubMed

18.

Pandolfino JE, Kim H, Ghosh SK, Clarke JO, Zhang Q, Kahrilas PJ (2007) High-resolution manometry of the EGJ: an analysis of crural diaphragm function in GERD. Am J Gastroenterol 102(5):1056–1063. https://doi.org/10.1111/j.1572-0241.2007.01138.x CrossRefPubMed

19.

Conklin JL (2013) Evaluation of esophageal motor function with high-resolution manometry. J Neurogastroenterol Motil 19(3):281–294. https://doi.org/10.5056/jnm.2013.19.3.281 CrossRefPubMedPubMedCentral

20.

Kahrilas PJ, Kim HC, Pandolfino JE (2008) Approaches to the diagnosis and grading of hiatal hernia. Best Pract Res Clin Gastroenterol 22(4):601–616. https://doi.org/10.1016/j.bpg.2007.12.007 CrossRefPubMedPubMedCentral

21.

Santonicola A, Angrisani L, Cutolo P, Formisano G, Iovino P (2014) The effect of laparoscopic sleeve gastrectomy with or without hiatal hernia repair on gastroesophageal reflux disease in obese patients. Surg Obes Relat Dis 10(2):250–255. https://doi.org/10.1016/j.soard.2013.09.006 CrossRefPubMed

22.

Angrisani L, Santonicola A, Hasani A, Nosso G, Capaldo B, Iovino P (2016) Five-year results of laparoscopic sleeve gastrectomy: effects on gastroesophageal reflux disease symptoms and co-morbidities. Surg Obes Relat Dis 12(5):960–968. https://doi.org/10.1016/j.soard.2015.09.014 CrossRefPubMed

23.

Angrisani L, Vitiello A, Santonicola A, Hasani A, De Luca M, Iovino P (2017) Roux-en-Y gastric bypass versus sleeve gastrectomy as revisional procedures after adjustable gastric band: 5-year outcomes. Obes Surg 27(6):1430–1437. https://doi.org/10.1007/s11695-016-2502-8 CrossRefPubMed

24.

Edeani F, Malik A, Kaul A (2017) Characterization of esophageal motility disorders in children presenting with dysphagia using high-resolution manometry. Curr Gastroenterol Rep 19(3):13. https://doi.org/10.1007/s11894-017-0549-x CrossRefPubMed

25.

Gyawali CP, Roman S, Bredenoord AJ, Fox M, Keller J, Pandolfino JE, Sifrim D, Tatum R, Yadlapati R, Savarino E (2017) Classification of esophageal motor findings in gastro-esophageal reflux disease: conclusions from an international consensus group. Neurogastroenterol Motil. https://doi.org/10.1111/nmo.13104 CrossRefPubMedPubMedCentral

26.

Tolone S, Savarino E, Zaninotto G, Gyawali CP, Frazzoni M, de Bortoli N, Frazzoni L, del Genio G, Bodini G, Furnari M, Savarino V, Docimo L (2018) High-resolution manometry is superior to endoscopy and radiology in assessing and grading sliding hiatal hernia: a comparison with surgical in vivo evaluation. United Eur Gastroenterol J 6(7):981–989. https://doi.org/10.1177/2050640618769160 CrossRef

27.

Fornari F, Gurski RR, Navarini D, Thiesen V, Mestriner LH, Madalosso CA (2010) Clinical utility of endoscopy and barium swallow X-ray in the diagnosis of sliding hiatal hernia in morbidly obese patients: a study before and after gastric bypass. Obes Surg 20(6):702–708. https://doi.org/10.1007/s11695-009-9971-y CrossRefPubMed

28.

Bennett S, Gostimir M, Shorr R, Mallick R, Mamazza J, Neville A (2016) The role of routine preoperative upper endoscopy in bariatric surgery: a systematic review and meta-analysis. Surg Obes Relat Dis 12(5):1116–1125. https://doi.org/10.1016/j.soard.2016.04.012 CrossRefPubMed

29.

Wolter S, Dupree A, Miro J, Schroeder C, Jansen MI, Schulze-Zur-Wiesch C, Groth S, Izbicki J, Mann O, Busch P (2017) Upper gastrointestinal endoscopy prior to bariatric surgery-mandatory or expendable? An analysis of 801 cases. Obes Surg 27(8):1938–1943. https://doi.org/10.1007/s11695-017-2622-9 CrossRefPubMed

30.

Evans JA, Muthusamy VR, Acosta RD, Bruining DH, Chandrasekhara V, Chathadi KV, Eloubeidi MA, Fanelli RD, Faulx AL, Fonkalsrud L, Khashab MA, Lightdale JR, Pasha SF, Saltzman JR, Shaukat A, Wang A, Stefanidis D, Richardson WS, Khothari SN, Cash BD (2015) The role of endoscopy in the bariatric surgery patient. Surg Obes Relat Dis 11(3):507–517. https://doi.org/10.1016/j.soard.2015.02.015 CrossRefPubMed

31.

Armour Forse R (2013) Comment on: prevalence of hiatal hernia in the morbidly obese. Surg Obes Relat Dis 9(6):924–925. https://doi.org/10.1016/j.soard.2013.04.005 CrossRefPubMed

32.

Alvarez Herrero L, Curvers WL, van Vilsteren FG, Wolfsen H, Ragunath K, Wong Kee Song LM, Mallant-Hent RC, van Oijen A, Scholten P, Schoon EJ, Schenk EB, Weusten BL, Bergman JG (2013) Validation of the Prague C&M classification of Barrett’s esophagus in clinical practice. Endoscopy 45(11):876–882. https://doi.org/10.1055/s-0033-1344952 CrossRefPubMed

Title: Hiatal hernia diagnosis prospectively assessed in obese patients before bariatric surgery: accuracy of high-resolution manometry taking intraoperative diagnosis as reference standard
Authors: Antonella Santonicola
Luigi Angrisani
Antonio Vitiello
Salvatore Tolone
Nigel John Trudgill
Carolina Ciacci
Paola Iovino
Publication date: 01-03-2020
Publisher: Springer US
Keywords: Obesity
Esophagography
Obesity
Bariatric Surgery
Bariatric Surgery
Upper and Lower Gastrointestinal Endoscopy
Published in: Surgical Endoscopy / Issue 3/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-019-06865-0

At a glance: The STEP trials

Springer Medicine

Hiatal hernia diagnosis prospectively assessed in obese patients before bariatric surgery: accuracy of high-resolution manometry taking intraoperative diagnosis as reference standard

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2020

Are online surgical discussion boards a safe and useful venue for surgeons to ask for advice? A review of the International Hernia Collaboration Facebook Group

Laparoscopic and open surgery in rectal cancer patients in Germany: short and long-term results of a large 10-year population-based cohort

Performance of Indocyanine green for sentinel lymph node mapping and lymph node metastasis in colorectal cancer: a diagnostic test accuracy meta-analysis

Correction to: Efficacy and safety of endoscopic balloon dilation in inflammatory bowel disease: results of the large multicenter study of the ENEIDA registry

Effects of totally extraperitoneal and lichtenstein hernia repair on men’s sexual function and quality of life

Rectal eversion: safe and effective way to achieve low transaction in minimally invasive Ileal pouch-anal anastomosis surgery, short- and long-term outcomes