INEFFECTIVE ESOPHAGEAL MOTILITY IS ASSOCIATED WITH A WORST CLINICAL OUTCOME AFTER TRANSORAL INCISIONLESS FUNDOPLICATION

Aims:

Transoral incisionless fundoplication (TIF) for the treatment of gastro-esophageal reflux disease (GERD) can be performed with two different devices: Esophyx and, more recently, MUSE system. Aim of this study was to evaluate the relationship between the presence of ineffective esophageal motility (IEM) before TIF and the clinical outcome of the procedure, assessed by proton pumps inhibitors (PPI) consumption 6 months after TIF.

Methods:

All patients were evaluated before TIF by esophageal conventional manometry (CM) or high resolution manometry (HRM). The definition of IEM were respectively: ≥30% of swallows with amplitude < 30 mmHg or simultaneous with amplitude < 30 mm Hg or dropped or failed, according to Castell et al., and ≥50% ineffective swallows (failed or weak: DCI< 100 or 450 mmHg*s*cm), according to Chicago v.3 Classification.

The clinical outcome 6 months after TIF was assessed by proton pumps inhibitors (PPI) consumption in 49 patients treated with Esophyx and 29 patients treated with MUSE.

The clinical outcome of TIF was compared between patients with IEM before TIF and patients with normal esophageal motility before TIF, using Fisher's exact test.

Results:

IEM was present before TIF in 18/49 (36.7%) patients treated with Esophyx and 9/29 (31%) patients treated with MUSE. In the IEM group 5/27 (18.5%) patients stopped PPI 6 months after TIF, while 22/27 (81.5%) patients halved PPI or assumed the same dose. In the group of patients with a normal esophageal motility before TIF, 23/51 (45.1%) patients stopped PPI 6 months after TIF, while 28/51 (54.9%) patients halved PPI or assumed the same dose (p = 0.019).

Conclusions:

IEM before TIF is statistically associated with a worst clinical outcome after the procedure.