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World J Gastroenterol. Apr 28, 2021; 27(16): 1751-1769
Published online Apr 28, 2021. doi: 10.3748/wjg.v27.i16.1751
Preoperative physiological esophageal assessment for anti-reflux surgery: A guide for surgeons on high-resolution manometry and pH testing
Michael Yodice, Alexandra Mignucci, Virali Shah, Christopher Ashley, Micheal Tadros
Michael Yodice, Alexandra Mignucci, Virali Shah, Department of Gastroenterology, Albany Medical College, Albany, NY 12208, United States
Christopher Ashley, Section of Gastroenterology, Stratton VA Medical Center, Albany, NY 12208, United States
Micheal Tadros, Department of Gastroenterology, Albany Medical Center, Schenectady, NY 12309, United States
Author contributions: Yodice M contributed as lead author with manuscript preparation. Mignucci A and Shah V contributed equally with manuscript preparation and critical review; Ashley C contributed critical review for the manuscript; Tadros M is the guarantor of the manuscript and also provided critical review.
Conflict-of-interest statement: The authors disclose no conflicts of interest or external funding for this publication.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Micheal Tadros, FACG, MD, Associate Professor, Doctor, Department of Gastroenterology, Albany Medical Center, 1769 Union Street 2nd Floor, Schenectady, NY 12309, United States. tadrosm1@amc.edu
Received: January 23, 2021
Peer-review started: January 23, 2021
First decision: February 10, 2021
Revised: February 18, 2021
Accepted: March 25, 2021
Article in press: March 25, 2021
Published online: April 28, 2021
Abstract

Gastroesophageal reflux disease (GERD) is one of the most commonly encountered digestive diseases in the world, with the prevalence continuing to increase. Many patients are successfully treated with lifestyle modifications and proton pump inhibitor therapy, but a subset of patients require more aggressive intervention for control of their symptoms. Surgical treatment with fundoplication is a viable option for patients with GERD, as it attempts to improve the integrity of the lower esophageal sphincter (LES). While surgery can be as effective as medical treatment, it can also be associated with side effects such as dysphagia, bloating, and abdominal pain. Therefore, a thorough pre-operative assessment is crucial to select appropriate surgical candidates. Newer technologies are becoming increasingly available to help clinicians identify patients with true LES dysfunction, such as pH-impedance studies and high-resolution manometry (HRM). Pre-operative evaluation should be aimed at confirming the diagnosis of GERD, ruling out any major motility disorders, and selecting appropriate surgical candidates. HRM and pH testing are key tests to consider for patients with GERD like symptoms, and the addition of provocative measures such as straight leg raises and multiple rapid swallows to HRM protocol can assess the presence of underlying hiatal hernias and to test a patient’s peristaltic reserve prior to surgery.

Keywords: Gastroesophageal reflux disease, Fundoplication, High resolution manometry, pH-impedance, Anti-reflux surgery, Pre-operative assessment

Core Tip: The goal of this review is to discuss recent technological advancements that have utility for patients with gastroesophageal reflux disease (GERD) as a pre-operative assessment for anti-reflux surgery. Surgical treatment of GERD is centered around improving the integrity of the lower esophageal sphincter, therefore it is crucial to rule out other esophageal pathologies that may present with GERD-like symptoms. Advances in pH-impedance studies allow for assessment of patients with weak acid reflux of non-erosive reflux disease. High resolution manometry with the addition of provocative measures can uncover underlying esophageal motility disorders with GERD-like symptoms.