Persistent dysphagia occurs in 5 to 10% of patients after fundoplication.
| Nadir lower esophageal sphincter relaxation pressure was the only predictor of success.|
|American Journal of Gastroenterology|
The cause of this is obscure in the majority of cases, and management has not been well established.
In this study, published in the December issue of the American Journal of Gastroenterology, researchers sought to evaluate outcomes and predictors of success for esophageal pneumatic dilations in patients with dysphagia after fundoplication.
The team retrospectively reviewed 14 patients who underwent pneumatic dilation for persistent postfundoplication dysphagia.
All patients had esophageal manometry before dilations.
The team identified 9 responders to pneumatic dilations (30 to 40 mm balloons).
They found that the nadir lower esophageal sphincter (LES) relaxation pressure was the only significant predictor for successful dilation. This was higher among the responders, than nonresponders (median 10 mm Hg versus 5 mm Hg).
In addition, 6 patients with nadir LES pressure ≥ 10 mm Hg all had a good response.
There was no significant difference in the LES basal pressure between the responders and nonresponders (median 20 mm Hg versus 12 mm Hg).
Furthermore, the median distal peristaltic amplitude, percent of failed peristalsis, and ramp pressure did not differ significantly between the responders and nonresponders.
No perforations occurred.
Dr Hui’s team concluded, “Pneumatic dilation is a reasonably safe and effective treatment for patients with postfundoplication dysphagia”.
“Raised nadir LES relaxation pressure seems to be a useful predictor of successful outcome”.