Components of high-resolution manometry that change surgical decisions

Area of Science:

• Gastroenterology
• Surgical Decision Making

Background:

• High-resolution manometry (HRM) is crucial for evaluating patients undergoing surgery at the gastroesophageal (GE) junction.
• Previous research indicated manometry alters GE junction surgery choices in over 50% of cases.
• Abnormal motility and distal contractile integral (DCI) are key components influencing these decisions.

Purpose of the Study:

• To examine how High-resolution manometry (HRM) characteristics, as defined by the Chicago classification, influence and alter intended surgical plans for foregut surgery.
• To identify specific HRM parameters that most impact surgical decision-making in patients undergoing GE junction procedures.

Main Methods:

• A retrospective analysis of 114 patients who underwent HRM studies between 2012 and 2016.
• Collected pre-operative data including symptoms, Upper GI X-rays, 48-h pH studies, DeMeester scores, upper endoscopy, and biopsy reports.
• HRM results were categorized using the Chicago classification, and Distal Contractile Integral (DCI) was determined. A single surgeon, blinded to patient identity and HRM results, initially determined the surgical plan, which was then revised after reviewing HRM findings.

Main Results:

• High-resolution manometry (HRM) altered the planned surgical procedure in 50.9% of cases (58/114).
• Abnormal motility findings were present in 54.4% of patients and corresponded to 70.6% of cases where surgery decisions were altered.
• A low Distal Contractile Integral (DCI < 1000) was observed in 31.6% of all patients but in 39.7% of cases with altered surgical plans. Low DCI and abnormal motility were associated with partial fundoplication.

Conclusions:

• Identifying abnormal motility using the Chicago classification significantly impacts surgical planning for GE junction procedures.
• Distal Contractile Integral (DCI) values are critical factors influencing surgical choices in foregut surgery.
• HRM findings demonstrably alter surgical plans, underscoring its importance in patient management.