Absence of Contraction Reserve Does Not Predict Late Post-Operative Dysphagia Following Anti-Reflux Surgery

Abstract

Purpose:

Anti-reflux surgery (ARS) is used to treat refractory gastro-oesophageal reflux disease (GORD) and late post-operative dysphagia (POD) is a possible complication. Oesophageal manometry metrics have been proposed to predict likelihood of POD. Some studies have demonstrated that lack of Contraction Reserve, defined as the ratio of distal contractile index (DCI) of multiple rapid swallows (MRS): single swallow (SS) <1, increases risk of late POD. We reviewed our experience to define any association between POD and contraction reserve.

Methods:

All patients from a single institution who underwent ARS between 2011 and 2021 with preoperative high-resolution manometry (HRM) and postoperative symptoms questionnaires (Visick score, GERD-HRQL and Eckhardt score) were included. The DCI MRS:SS ratio was calculated, and results were analysed using Stata.

Results:

Thirty-six patients were included, with excellent outcomes of minimal POD and low questionnaire scores: median Visick = 2 (max score 4), median GERD-HRQL = 4 (max score 50) and median Eckhardt = 1 (max score 12). Median follow-up was 5 years. Four patients (11.1%) had adequate contraction reserve. There was a weak positive correlation between contraction reserve and Eckhardt scores (r = .11, P = .713) and a weak inverse correlation between contraction reserve and Visick scores (r = −.18, P = .513).

Conclusion:

This is the first Australian study to examine the correlation between contraction reserve and postoperative dysphagia. No significant association was found. Any hypothesized relationship or correlation will need to be validated before incorporation into clinical guidelines.

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