Can the marshmallow esophagram replace high-resolution manometry as an appropriate screening for esophageal motility prior to anti-reflux surgery?

Abstract

Backgound: The purpose of our study was to evaluate the use of minimally invasive Marshmallow Swallow Study (MSS) as a preoperative screening technique for patients and correlate marshmallow results with High Resolution Manometry (HRM) results and post-operative dysphagia following antireflux surgery.

Methods: A retrospective electronic chart review of data on 61 adult patients undergoing MSS was completed. Patients were included if they completed the MSS as well as: HRM and/or antireflux surgery.

Results: Sixty-one patients completed MSS. Of the 37 patients that completed HRM, 27 had abnormal results. 23 of these 27 patients who had abnormal results also failed MSS. The NPV for a failure on the MSS and abnormal HRM results is 0.767(p-value = 0.360). The PPV for a pass on the MSS and no post-operative dysphagia is 0.833 (p-value = 0.656).

Conclusions: MSS is an effective screening tool for ruling out major esophageal motility disorders and can prevent need for invasive HRM.

Keywords: Dysphagia; Esophageal motility; High resolution manometry; Swallow study; anti-Reflux surgery.