The use of esophageal transit and gastric emptying studies in the evaluation of patients undergoing laparoscopic fundoplication

Abstract

Nuclear scintigraphic assessment of esophageal transit and gastric emptying are valuable, user-friendly tools to identify and avoid functional motility problems in the setting of fundoplication. These studies seem to be a reasonable alternative to manometry in assessing esophageal function before surgery in this setting. Postoperative symptoms may be related to objective changes in esophageal transit or gastric emptying. The causes may be iatrogenic in nature or related to vagal denervation with associated changes in esophagogastric compliance. Awareness of these physiologic changes may prompt further technical precautions at the time of surgery to avoid vagal injury and also may facilitate postoperative medical management.

The role of short-limb Roux-en-Y reconstruction for failed antireflux surgery: a single-center 5-year experience

“…Esophageal dysmotility and delayed gastric emptying can compromise the results of fundoplication, particularly in the setting of previous hiatal dissections [37][38][39][40]. Short esophagus requiring a lengthening procedure (i.e., Collis gastroplasty) represents major technical challenges in the presence of dense mediastinal scarring from previous mobilizations.…”

The UCD Experience with Classic Gastric Emptying Scintigraphy – Systematic Review and Meta-analysis

“…In another study, the gastric emptying rate is prolonged for those who still had reflux symptoms after Nissen fundoplication [22]. Although none of our patients had a partial (Toupet) fundoplication, a study involving 106 patients with Toupet fundoplication did not show statistically significant changes in gastric emptying time after the operation [23]. Gastric emptying scintigraphy was also found to poorly correlate with postoperative symptoms which may be from iatrogenic or related to vagal denervation.…”

Evaluation and management of patients with symptoms after anti-reflux surgery

“…The role of nuclear scintigraphy as a less invasive alternative to assess esophageal and gastric function in patients undergoing fundoplication remains unclear. In a cohort of patients, scintigraphic assessment of emptying scores remained unchanged in the majority of patients undergoing ARS . Although in patients with baseline abnormal preoperative transit times, esophageal and gastric emptying times improved in one‐third and two‐thirds of patients, respectively.…”