Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 12/2010

01-12-2010

The use of esophageal transit and gastric emptying studies in the evaluation of patients undergoing laparoscopic fundoplication

Authors: Matthew J. Schuchert, Brian L. Pettiford, Ghulam Abbas, Alicia Oostdyk, James R. Landreneau, Arman Kilic, Joshua P. Landreneau, James D. Luketich, Rodney J. Landreneau

Published in: Surgical Endoscopy | Issue 12/2010

Login to get access

Abstract

Background

Preservation of esophageal and gastric function is a hallmark principle in ensuring optimal surgical outcomes after gastric fundoplication. In this study, we evaluated the impact of fundoplication on esophageal transit and gastric emptying using scintigraphy studies and related these functional findings to symptomatic outcomes.

Methods

A total of 106 consecutive patients (37 women, 69 men) with both preoperative and 6-month postoperative nuclear scintigraphy studies undergoing partial (Toupet) fundoplication at a single institution were analyzed. Primary variables included alterations in esophageal transit and gastric emptying times after fundoplication (1 = rapid; 2 = normal; 3 = mild delay; 4 = severe delay). Symptomatic variables included heartburn, regurgitation, dysphagia, pulmonary symptoms, and bloating.

Results

Mean age was 57.2 years. Symptomatic improvement was achieved in 91.5% of patients. Significant reduction of all symptoms (heartburn, regurgitation, pulmonary symptoms, and dysphagia) was noted after fundoplication, except gas bloating (4.7 vs. 20.8%). There were no significant differences in preoperative and postoperative esophageal transit (2.53 vs. 2.52) and gastric emptying (2.13 vs. 2.06) scores after fundoplication. Interestingly, 17% of esophageal transit times and 18% of gastric emptying times improved after fundoplication. However, worsening scores were seen in 16 and 12%, respectively. There was no significant postoperative dysphagia, even in patients with impaired transit times.

Conclusions

Nuclear scintigraphic assessment of esophageal transit and gastric emptying are valuable, user-friendly tools to identify and avoid functional motility problems in the setting of fundoplication. These studies seem to be a reasonable alternative to manometry in assessing esophageal function before surgery in this setting. Postoperative symptoms may be related to objective changes in esophageal transit or gastric emptying. The causes may be iatrogenic in nature or related to vagal denervation with associated changes in esophagogastric compliance. Awareness of these physiologic changes may prompt further technical precautions at the time of surgery to avoid vagal injury and also may facilitate postoperative medical management.
Literature
1.
Devault KR, Castell DO (2005) Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol 100:190–200CrossRefPubMed
2.
DeMeester TR, Wang CI, Wernly JA, Pellegrini CA, Little AG, Klementschitch P, Bermudez G, Johnson LF, Skinner DB (1980) Technique, indications, and clinical use of 24 hour esophageal pH monitoring. J Thorac Cardiovasc Surg 79(5):656–670PubMed
3.
Bancewicz J, Osugi H, Marples M (1987) Clinical implications of abnormal oesophagel motility. Br J Surg 74:416–419CrossRefPubMed
4.
del Genio G, Tolone S, del Genio F, Aggarwal R, d’Allesandro A, Allaria A, Rossetti G, Brusciano L, del Genio A (2008) Prospective assessment of patient selection for antireflux surgery by combined multichannel intraluminal impedance pH monitoring. J Gastrointest Surg 12(9):1491–1496CrossRefPubMed
5.
Klein HA (1995) Esophageal transit scintigraphy. Sem Nucl Med 25(4):306–317CrossRef
6.
Velasco N, Hill LD, Gannan RM, Pope CE (1982) Gastric emptying and gastroesophagel reflux: effects of surgery and correlation with esophageal motor function. Am J Surg 144:58–62CrossRefPubMed
7.
Heider TR, Behrns KE, Koruda MJ, Shaheen NJ, Lucktong TA, Bradshaw B, Farrell TM (2003) Fundoplication improves disordered esophageal motility. J Gastrointest Surg 7:159–163CrossRefPubMed
8.
Hinder RA, Stein HJ, Bremner CG, DeMeester TR (1989) Relationship of a satisfactory outcome to normalization of delayed gastric emptying after Nissen fundoplication. Ann Surg 210(4):458–465CrossRefPubMed
9.
Stier AW, Stein HJ, Siewert JR, Schwaiger M (2000) Image processing in esophageal scintigraphy: topography of transit times. Dis Esoph 13(2):152–160CrossRef
10.
Wayman J, Myers JC, Jamieson GG (2007) Pre-operative gastric emptying and patterns of reflux as predictors of outcome after laparoscopic fundoplication. Br J Surg 94:592–598CrossRefPubMed
11.
Campos GM, Oberg S, Gastal O, Theisen J, Nigro JJ, Hagan JA, Costantini M, Bremner CG, DeMeester TR, Crookes PF (2003) Manometry of the lower esophageal sphincter: inter- and intraindividual variability of slow motorized pull-through versus station pull-through manometry. Dig Dis Sci 48(6):1057–1061CrossRefPubMed
12.
El-Sherif AE, Adusumilli PS, Pettiford BL, d’Amato TA, Schuchert MJ, Clark A, DiRenzo C, Landreneau JP, Luketich JD, Landreneau RJ (2007) Laparoscopic clam shell partial fundoplication achieves effective reflux control with reduced postoperative dysphagia and gas bloating. Ann Thorac Surg 84(5):1704–1709CrossRefPubMed
13.
Campos GM, Peters JH, DeMeester TR, Oberg S, Crookes PF, Tan S, DeMeester SR, Hagan JA, Bremner CG (1999) Multivariate analysis of factors predicting outcome after laparoscopic Nissen fundoplication. J Gastrointest Surg 3(3):292–300CrossRefPubMed
14.
Jackson PG, Gleiber MA, Askari R, Evans SR (2001) Predictors of outcome in 100 consecutive laparoscopic antireflux procedures. Am J Surg 181(3):231–235CrossRefPubMed
15.
Patti MG, Fisichella PM, Perretta S (2001) Pre-operative evaluation of patients with gastroesophageal reflux disease. J Laparoendosc Surg 11(6):327–331CrossRef
16.
Watson TJ, Peters JH (2005) Evaluation of esophageal function for anti-reflux surgery. Gastrointest Endosc Clin N Am 15(2):347–360CrossRefPubMed
17.
Velanovich V, Mahatme A (2004) Effects of manometrically discovered nonspecific motility disorders of the esophagus on the outcomes of anti-reflux surgery. J Gastrointest Surg 8(3):335–341CrossRefPubMed
18.
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 pre-operative esophageal motility. Surg Endosc 22:21–30CrossRefPubMed
19.
Sood A, Gambhir S, Sewatkar AB, Deswal S, Sarswat V, Kumar R (2004) Esophageal motor disorder diagnosed by esophageal transit scintigraphy. Clin Nucl Med 29(11):768–769CrossRefPubMed
20.
Waring JP, Hunter JG, Oddsdottir M, Wo J, Katz E (1995) The pre-operative evaluation of patients considered for laparoscopic anti-reflux surgery. Am J Gastroenterol 90(1):35–38PubMed
21.
Booth MI, Stratford J, Jones L, Dehn TCB (2008) Randomized clinical trial of laparoscopic total (Nissen) versus posterior partial (Toupet) fundoplication for gastro-oesophagel reflux disease based on pre-operative esophageal manometry. Br J Surg 95:57–63CrossRefPubMed
22.
Lund RJ, Wetcher GJ, Raiser F, Glaser K, Perdikis G, Gadenstätter M, Katada N, Filipi CJ, Hinder RA (1997) Laparoscopic Toupet fundoplication for gastroesophageal reflux disease with poor esophageal body motility. J Gastrointest Surg 1:301–308CrossRefPubMed
23.
Mughal MM, Bancewicz J, Marples M (1990) Oesophagel manometry and pH recording does not predict the bad results of Nissen fundoplication. Br J Surg 7:3–45
24.
Kazem I (1972) A new scintigraphic technique for the study of the esophagus. Am J Roentgenol Radium Ther Nucl Med 115(4):681–688PubMed
25.
Tolin RD, Malmud LS, Reilley J, Fisher RS (1979) Esophageal scintigraphy to quantitate esophageal transit (quantitation of esophageal transit). Gastroenterology 76(6):1402–1408PubMed
26.
de Caestecker JS, Blackwell JN, Adam RD, Hannan WJ, Brown J, Heading RC (1986) Clinical value of radionuclide oesophageal transit measurement. Gut 27(6):659–666CrossRefPubMed
27.
Mughal MM, Marples M, Bancewicz J (1986) Scintigraphic assessment of oesophageal motility: what does it show and how reliable is it? Gut 27(8):946–953CrossRefPubMed
28.
Taillefer R, Jadliwalla M, Pellerin E, Lafontaine E, Duranceau A (1990) Radionuclide esophageal transit study in detection of esophageal motor dysfunction: comparison with motility studies (manometry). J Nucl Med 31(12):1921–1926PubMed
29.
Tatsch K, Voderholzer WA, Weiss MJ, Schrottle W, Hahn K (1996) Reappraisal of quantitative esophageal scintigraphy by optimizing results with ROC analyses. J Nucl Med 37(11):1799–1805PubMed
30.
Bestetti A, Carola F, Conciato L, Marasini B, Tarolo GL (1999) Esophageal scintigraphy with a semisolid meal to evaluate esophageal dysmotility in systemic sclerosis and Raynaud’s phenomenon. J Nucl Med 40(1):77–84PubMed
31.
Prasek J, Hep A, Dolina J, Dite P (2000) Dynamic esophageal scintigraphy in patients with achalasia. Nucl Med Rev Cent East Eur 3(1):57–60PubMed
32.
Parkman HP, Maurer AH, Caroline DF, Miller DL, Krevsky B, Fisher RS (1996) Optimal evaluation of patients with nonobstructive esophageal dysphagia. Manometry, scintigraphy, or videoesophagography? Dig Dis Sci 41(7):1355–1368CrossRefPubMed
33.
Lindeboom MYA, Ringers J, van Rijn PJJ, Neijenhuis P, Stokkel MPM, Masclee AAM (2004) Gastric emptying and vagus nerve function after laparoscopic partial fundoplication. Ann Surg 240(5):785–790CrossRefPubMed
34.
Maddern GJ, Jamiesson GG (1985) Fundoplication enhances gastric emptying. Ann Sur 201(3):296–299CrossRef
35.
Viljakka M, Saali K, Koskinen M, Karhumäki L, Kössi J, Luostarinen M, Terrenhovi O, Isolauri J (1999) Anti-reflux surgery enhances gastric emptying. Arch Surg 134:18–31CrossRefPubMed
36.
Wykypiel H, Hugl B, Gadenstaetter M, Bonatti H, Bodner J, Wetscher GJ (2008) Laparoscopic partial posterior (Toupet) fundoplication improves esophageal bolus propagation on scintigraphy. Surg Endosc 22:1845–1851CrossRefPubMed
37.
Collis JL, Kelly TD, Wiley AM (1954) Anatomy of the crura of the diaphragm and surgery of hiatus hernia. Thorax 9:175–189CrossRefPubMed
38.
Hill LD, Kozarek RA, Kraemer SJ, Aye RW, Mercer CD, Low DE, Pope CE II (1996) The gastroesophageal flap valve: in vitro and in vivo observations. Gastrointest Endosc 44(5):541–547CrossRefPubMed
39.
Bredenoord AJ, Chial HJ, Camilleri M, Mullan BP, Murray JA (2003) Gastric accommodation and emptying in evaluation of patients with upper gastrointestinal symptoms. Clin Gastroenterol Hepatol 1(4):264–272CrossRefPubMed
40.
Johnson DG, Reid BS, Meyers RL, Fry MA, Nortmann CA, Jackson WD, Marty TL (1998) Are scintiscans accurate for the selection of reflux patients for pyloroplasty? J Pediatr Surg 33:573–579CrossRefPubMed
Metadata
Title
The use of esophageal transit and gastric emptying studies in the evaluation of patients undergoing laparoscopic fundoplication
Authors
Matthew J. Schuchert
Brian L. Pettiford
Ghulam Abbas
Alicia Oostdyk
James R. Landreneau
Arman Kilic
Joshua P. Landreneau
James D. Luketich
Rodney J. Landreneau
Publication date
01-12-2010
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 12/2010
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-010-1099-6

Other articles of this Issue 12/2010

Surgical Endoscopy 12/2010 Go to the issue

OriginalPaper

A retrospective audit comparing outcomes of open versus laparoscopic repair of umbilical/paraumbilical herniae

Review

Colonic perforation in collagenous colitis: a systematic review of a rare complication and guidance on management

OriginalPaper

Evaluation of a video-based curriculum for laparoscopic biliary surgery: a pilot study from the SAGES MIS Web Learning Center

OriginalPaper

Cholecystectomy prevalence and treatment cost: an 8-year study in Taiwan

OriginalPaper

Appendectomy using single-incision pediatric endosurgery for acute and perforated appendicitis

OriginalPaper

Single-port cholecystectomy: small scar, short learning curve