High-resolution manometry findings after Linx procedure for gastro-esophageal reflux disease

Neurogastroenterol Motil. 2020 Mar;32(3):e13750. doi: 10.1111/nmo.13750. Epub 2019 Oct 21.

Abstract

Background: Magnetic sphincter augmentation with the Linx® system is a novel laparoscopic procedure for the treatment of gastro-esophageal reflux disease (GERD). Only few data are available regarding the impact of Linx on high-resolution manometry (HRM) variables.

Methods: The prospectively collected database of patients who underwent Linx procedure at a single institution was queried. All patients who completed pre- and postoperative HRM, GERD health-related quality of life (GERD-HRQL) questionnaire, and functional outcome swallowing scale (FOSS) questionnaire were included in the study.

Key results: Forty-five out of 304 patients were included. At a median follow-up of 12 months (IQR 10) after surgery, a statistically significant increase of lower esophageal sphincter (LES) total length (P = .002), intra-abdominal length (P = .001), integrated relaxation pressure (IRP), intrabolus pressure (IBP), and esophagogastric contractile integral (EGJ-CI) was noted (P < .001). Distal esophageal amplitude (P = .004), mean distal contractile integral (DCI) (P < .001), post multiple repeated swallows DCI (P = .001), and the percent of normal peristalsis increased (P = .040). All patients were relieved of reflux symptoms. Ineffective esophageal motility reversed to normal in 36% of patients after surgery. The only factor significantly associated with postoperative dysphagia was preoperative dysphagia (P = .006). Postoperatively, a significant correlation between IRP and DCI (r = 0.361 and P = .019) and between IBP and DCI (r = 0.443 and P = .003) was found.

Conclusions and inferences: The Linx procedure had a remarkable effect on esophageal motility in the short-term follow-up. It appears that the overall postoperative increase of IRP and IBP may justify the higher DCI values. Preoperative dysphagia was the only factor associated with postoperative dysphagia.

Keywords: dysphagia; gastro-esophageal reflux disease; high-resolution manometry; laparoscopic surgery; linx procedure; magnetic sphincter augmentation.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Female
  • Fundoplication / instrumentation*
  • Fundoplication / methods*
  • Gastroesophageal Reflux / surgery*
  • Humans
  • Laparoscopy / instrumentation
  • Laparoscopy / methods
  • Male
  • Manometry
  • Middle Aged
  • Retrospective Studies
  • Treatment Outcome*