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Laparoscopic fundoplication (LF), even if performed in specialized centers, can be followed by long-term side effects such as dysphagia, gas bloating or inability to belch. Patients with an ineffective esophageal motility (IEM) and concurrent GERD are prone to postoperative dysphagia after LF. The aim of this study is to evaluate the safety and efficacy of electrical lower esophageal sphincter stimulation in patients with IEM and GERD.
This is a prospective, open-label single center study. Patients with PPI-refractory GERD and ineffective esophageal motility were included for lower esophageal sphincter electrical stimulation (LES-EST). Patients underwent prospective follow-up including physical examination, interrogation of the device and were surveyed for changes in the health-related quality of life score.
According to power analysis, 17 patients were included in this study. Median distal contractile integral (DCI) was 64 mmHg s cm (quartiles 11.5–301). Median total % pH < 4 was 8.9 (quartiles 4–21.6). Twelve patients (70.6%) underwent additional hiatal repair. At 1-month follow-up, none of the patients showed any clinical or radiological signs of dysphagia. There were no procedure related severe adverse events. Mean total HQRL improved from baseline 37.53 (SD 15.07) to 10.93 (SD 9.18) at follow-up (FUP) (mean difference 24.0 CI 15.93–32.07) p < 0.001.
LES-EST was introduced as a potential technique to avoid side effects of LF. LES-EST significantly improved health related quality of life and does not impair swallowing in patients with GERD and ineffective esophageal motility.
El-Serag HB, Sweet S, Winchester CC, Dent J (2014) Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 63:871–880 CrossRef
Subramanian CR, Triadafilopoulos G (2015) Refractory gastroesophageal reflux disease. Gastroenterol Rep (Oxf) 3:41–53 CrossRef
Richter JE (2013) Gastroesophageal reflux disease treatment: side effects and complications of fundoplication. Clin Gastroenterol Hepatol 11::465–471 (quiz e439) CrossRef
Novitsky YW, Wong J, Kercher KW, Litwin DE, Swanstrom LL, Heniford BT (2007) Severely disordered esophageal peristalsis is not a contraindication to laparoscopic Nissen fundoplication. Surg Endosc 21:950–954 CrossRef
Rodriguez L, Rodriguez P, Neto MG, Ayala JC, Saba J, Berel D, Conklin J, Soffer E (2012) Short-term electrical stimulation of the lower esophageal sphincter increases sphincter pressure in patients with gastroesophageal reflux disease. Neurogastroenterol Motil 24:446–450 CrossRef
Rodriguez L, Rodriguez PA, Gomez B, Netto MG, Crowell MD, Soffer E (2016) Electrical stimulation therapy of the lower esophageal sphincter is successful in treating GERD: long-term 3-year results. Surg Endosc 30:2666–2672 CrossRef
Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, Pandolfino JE, International High Resolution Manometry Working G (2015) The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil 27:160–174 CrossRef
Velanovich V (1998) Comparison of generic (SF-36) vs. disease-specific (GERD-HRQL) quality-of-life scales for gastroesophageal reflux disease. J Gastrointest Surg 2:141–145 CrossRef
Mellow MH, Pinkas H (1984) Endoscopic therapy for esophageal carcinoma with Nd:YAG laser: prospective evaluation of efficacy, complications, and survival. Gastrointest Endosc 30:334–339 CrossRef
Kappelle WF, Bredenoord AJ, Conchillo JM, Ruurda JP, Bouvy ND, van Berge Henegouwen MI, Chiu PW, Booth M, Hani A, Reddy DN, Bogte A, Smout AJ, Wu JC, Escalona A, Valdovinos MA, Torres-Villalobos G, Siersema PD (2015) Electrical stimulation therapy of the lower oesophageal sphincter for refractory gastro-oesophageal reflux disease—interim results of an international multicentre trial. Aliment Pharmacol Ther 42:614–625 CrossRef
Rodriguez L, Rodriguez P, Gomez B, Ayala JC, Saba J, Perez-Castilla A, Galvao Neto M, Crowell MD (2013) Electrical stimulation therapy of the lower esophageal sphincter is successful in treating GERD: final results of open-label prospective trial. Surg Endosc 27:1083–1092 CrossRef
Falcao A, Nasi A, Brandao J, Sallum R, Cecconello I (2013) What is the real impairment on esophageal motility in patients with gastroesophageal reflux disease? Arq Gastroenterol 50:111–116 CrossRef
Kasamatsu S, Matsumura T, Ohta Y, Hamanaka S, Ishigami H, Taida T, Okimoto K, Saito K, Maruoka D, Nakagawa T, Katsuno T, Fujie M, Kikuchi A, Arai M (2017) The effect of ineffective esophageal motility on gastroesophageal reflux disease. Digestion 95:221–228 CrossRef
Felix VN, DeVault K, Penagini R, Elvevi A, Swanstrom L, Wassenaar E, Crespin OM, Pellegrini CA, Wong R (2013) Causes and treatments of achalasia, and primary disorders of the esophageal body. Ann N Y Acad Sci 1300:236–249 CrossRef
Chrysos E, Prokopakis G, Athanasakis E, Pechlivanides G, Tsiaoussis J, Mantides A, Xynos E (2003) Factors affecting esophageal motility in gastroesophageal reflux disease. Arch Surg 138:241–246 CrossRef
Fuchs HF, Gutschow CA, Brinkmann S, Herbold T, Bludau M, Schroder W, Bollschweiler E, Holscher AH, Leers JM (2014) Effect of laparoscopic antireflux surgery on esophageal motility. Dig Surg 31:354–358 CrossRef
Pandolfino JE, Fox MR, Bredenoord AJ, Kahrilas PJ (2009) High-resolution manometry in clinical practice: utilizing pressure topography to classify oesophageal motility abnormalities. Neurogastroenterol Motil 21:796–806 CrossRef
Kapadia S, Osler T, Lee A, Borrazzo E (2017) The role of preoperative high resolution manometry in predicting dysphagia after laparoscopic Nissen fundoplication. Surg Endosc 32(5):2365–2372. CrossRef
Eypasch E (2014) Electrical stimulation of the lower oesophageal sphincter: an emerging therapy for treatment of GORD. Eur Surg 46:57–64 CrossRef
Furnee EJ, Draaisma WA, Gooszen HG, Hazebroek EJ, Smout AJ, Broeders IA (2011) Tailored or routine addition of an antireflux fundoplication in laparoscopic large hiatal hernia repair: a comparative cohort study. World J Surg 35:78–84 CrossRef
- Electrical lower esophageal sphincter augmentation in patients with GERD and severe ineffective esophageal motility—a safety and efficacy study
Sebastian F. Schoppmann
- Springer US
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