Original Article

Journal of Gastrointestinal Surgery

, Volume 14, Issue 2, pp 268-276

First online:

Esophagogastric Junction Distensibility After Fundoplication Assessed with a Novel Functional Luminal Imaging Probe

  • Monika A. KwiatekAffiliated withDepartment of Medicine, Feinberg School of Medicine, Northwestern UniversityDivision of Gastroenterology, Department of Medicine, Feinberg School of Medicine, Northwestern University Email author 
  • , Peter J. KahrilasAffiliated withDepartment of Medicine, Feinberg School of Medicine, Northwestern University
  • , Nathaniel J. SoperAffiliated withDepartment of Surgery, Feinberg School of Medicine, Northwestern University
  • , William J. BulsiewiczAffiliated withDepartment of Medicine, Feinberg School of Medicine, Northwestern University
  • , Barry P. McMahonAffiliated withMedical Physics & Clinical Engineering, Department of Clinical Medicine, Trinity College
  • , Hans GregersenAffiliated withMech-Sense, Aalborg Hospital, Århus University Hospital
  • , John E. PandolfinoAffiliated withDepartment of Medicine, Feinberg School of Medicine, Northwestern University

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Abstract

Objective

The aim of the study was to compare the esophagogastric junction (EGJ) compliance in response to controlled distension in fundoplication (FP) patients and controls using the functional luminal imaging probe (FLIP).

Background

FP aims to replicate normal EGJ distensibility. FLIP is a new technology that uses impedance planimetry to measure intraluminal cross-sectional area (CSA) during controlled distension.

Methods

Ten controls and ten FP patients were studied with high-resolution esophageal pressure topography (HREPT) and then the FLIP placed across the EGJ. Deglutitive and interdeglutitive EGJ distensibility was assessed with volume-controlled distension. The FLIP measured eight CSAs spaced 4 mm apart within a cylindrical saline-filled bag along with the corresponding intrabag pressure.

Results

The EGJ formed an hourglass shape during distensions with the central constriction at the diaphragmatic hiatus. The distensibility of the hiatus was significantly greater during deglutitive relaxation in both subject groups, but FP patients exhibited reduced EGJ distensibility and compliance compared to controls. During the interglutitive period, the corresponding increase in intrabag pressures at larger volumes were also greater in FP patients implying a longer segment of EGJ constriction. The EGJ distensibility characteristics did not correlate with HREPT measures.

Conclusions

FLIP technology was used to compare EGJ distensibility in FP patients and control subjects. The least distensible locus within the EGJ was always at the hiatus. EGJ distensibility was significantly reduced, and the length of constriction increased in FP patients. Future FLIP studies will compare patients with and without post-FP dysphagia and gas bloat, symptoms suggestive of an overly restrictive FP.

Keywords

Esophagogastric junction Fundoplication Functional luminal imaging probe Manometry