Alpha Omega Alpha Honor Medical Society

2012 Research Abstract

High Resolution Manometry to Analyze Esophageal Motility and GERD in Bariatric Patients

Investigator: Parth Khade, BS, Texas A&M Health Science Center College of Medicine

Mentor: Joseph Kuhn, MD, FACS, Baylor University Medical Center, Dallas, Texas

Background: Gastric reflux symptoms represent the most common potential complication following sleeve gastrectomy. Pre-operative assessment of esophageal motility, hiatal hernia, and reflux are important components to determine the appropriateness of this operation, as a subset of patients presenting with symptoms of GERD may be suffering from underlying sliding hiatal hernia (HH), and thus may require an additional correctional operation. High resolution manometry is specifically beneficial in HH patients because it can detect distinct areas of elevated pressure within the LES and crural diaphragm. The purpose of this study was to determine the role of esophageal manometry as a diagnostic and screening tool prior to sleeve gastrectomy.

Methods: A retrospective review of a prospective sleeve gastrectomy database was analyzed for standardized GERD scores, high resolution manometry with impedance measurements, and operative findings. 79 patients who underwent sleeve gastrectomy were divided into two groups—a group of 48 patients shown to have hiatal hernia during sleeve gastrectomy, and a control group of 31 patients. GERD-HRQL scale symptoms were assessed pre-operatively for all patients. Manometry readings were performed through the placement of intraluminal pressure sensors to detect both tonic and phasic components of the EGJ.

Results: Proximal LES length (p = 0.0144) and intraabdominal LES length (p = 0.0018) detected during manometry readings were shown to be significant predictors for presence of hiatal hernia. The mean intraabdominal LES lengths in the control and HH groups were 1.81 cm and 2.33 cm, respectively. Incomplete bolus clearance of 26.58% was seen in the HH group, while incomplete bolus clearance of 12.52% was seen in the control group. GERD-HRQL scores were found to be higher in the HH group (mean = 7.19) as compared to the control group (mean = 5.64).

Conclusions: Esophageal manometry with impedance offers a unique tool to guide surgeons and patients regarding the appropriateness of sleeve gastrectomy based on the degree of preoperative reflux, LES pressure, esophageal motility, and degree of hiatal hernia. Proximal LES length and intraabdominal LES length were found to be significant predictors.

Updated on August 5, 2013.


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