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Preoperative physiological esophageal assessment for anti-reflux surgery:A guide for surgeons on high-resolution manometry and pH testing

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World Journal of Gastroenterology 2021年第16期27卷 1751-1769页

作者： Michael Yodice Alexandra Mignucci virali shah Christopher Ashley Micheal Tadros Department of Gastroenterology Albany Medical CollegeAlbanyNY 12208United States Section of Gastroenterology Stratton VA Medical CenterAlbanyNY 12208United States Department of Gastroenterology Albany Medical CenterSchenectadyNY 12309United States

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

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

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