Abstract

APONTE, Raúl et al. Functional evaluation of the gastroesophageal junction (GEJ) before and after anti reflux fundoplication. usefulness of impedance planimetry (Endoflip®). Gen [online]. 2016, vol.70, n.1, pp.006-015. ISSN 2477-975X.

The increase of the distensibility of the gastro-esophageal junction (GEJ) is a factor in the development of the gastroesophageal reflux disease (GERD). GERD patients show more distensibility when compared to healthy subjects. Objectives: To evaluate the distensibility of the GEJ after the laparoscopic fundoplication (LF) through the distensibility index (DI). Patients and Methods: A prospective, observational cohort study that included 25 symptomatic GERD patients was conducted. The diagnosis was confirmed by gastroscopy, high resolution manometry (HRM) and impedance-pH study. The length of the hiatal hernia (HH), the esophageal peristalsis and the distal contraction index (DCI) were measured. Pressure and distensibility measurements of the GEJ were obtained with the EndoFlip® system in 3 moments of the surgery: with the pneumo peritoneum stabilization, after the closure of the diaphragmatic gap and intra abdominal esophagus segment refund and after the covering. Values between 25 and 35 mmHg of pressure of the GEJ, reduction of distensibility over 40% of the initial value and DI below 1.5 mmHg, were considered as an optimal outcome of the intervention. Results: 25 patients were evaluated, 16 women, (av. 44 years). The average resting pressure of the lower esophageal sphincter (LES) of 9.1 mmHg, HH of 3.69 cm length. The % of normal peristalsis was 17.4% and DCI 341.1 mmHg/cm/s. The initial measurement with the EndoFlip® was 12.58 mmHg pressure of the LES, distensibility between 46.1 and 76 mm2/mmHg. The second measurement showed pressure increase to 21.39 mmHg (> 58.6% from initial value) and the distensibility lowered to 41.1 mm2/mmHg (<31.2%). After the fundoplication it registered elevation of pressure to an optimal average value of 33 mmHg, being over 25 mmHg in every case, and the distensibility lowered to 28.6 mm2/mmHg (<50.7%). The average DI final was 0.87 mmHg. (0.62 - 1.17). The registered changes of pressure and distensibility showed a highly significant difference (p< 0, 0001). An antagonist correlation between the length of the HH and the pressure of the GEJ measured by EndoFlip® (p< 0.05) was found. Conclusion: Significant decrease of the DI of the GEJ was observed after the LF measured through the EndoFlip® system.

Keywords : gastroesophageal reflux disease; pressure; distensibility.