PS01.024: ENDOSTIMTM THERAPY IN PATIENTS WITH ESOPHAGEAL MOTILITY DISORDERS

Abstract Background Electric stimulation of the lower esophageal sphincter is a new surgical option for patients with gastroesophageal reflux disease (GERD) and a diaphragmatic hernia less than 3 cm. In comparison to standard anti-reflux procedures like Nissen or Toupet fundoplication the procedure`s advantage is that there had been no report on postoperative dysphagia. Esophageal motility disorders can increase the risk of dysphagia after fundoplication. Therefor EndostimÔ might be an alternative for these patients. Methods Between December 2015 and November 2017 twelve patients with GERD received Endostim™ therapy. All patients underwent endoscopy, high resolution impedance manometry (HRIM), 24 hour impedance pH-monitoring and a barium swallow. Quality of life was assessed by GERD-HRLQ a validated questionnaire. Results Seven patients with an esophageal motility disorder received an Endostim™ due to symptomatic GERD. Three patients had an esophageal hypomotility, 2 patients had a CREST syndrome and 2 patients showed a functional outflow obstruction in HRIM. There were no postsurgical complications. No dysphagia, regurgitation or retrosternal pain was reported. After a follow up of 6 months all patients are satisfied with the procedure and report an increase of their quality of life. Conclusion These results demonstrate the feasibility of an Endostim™ therapy in patients with esophageal motility disorders for the first time. Disclosure All authors have declared no conflicts of interest.

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Esophageal Motility Disorders in the Natural History of Acid-Dependent Causes of Dysphagia and Their Influence on Patients’ Quality of Life—A Prospective Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182111138 ◽

2021 ◽

Vol 18 (21) ◽

pp. 11138

Author(s):

Joanna Sarbinowska ◽

Benita Wiatrak ◽

Dorota Waśko-Czopnik

Keyword(s):

Quality Of Life ◽

Natural History ◽

Esophageal Motility ◽

Assessment Tool ◽

Motor Dysfunction ◽

Esophageal Motility Disorders ◽

High Power Field ◽

Motility Disorders ◽

Schatzki Ring

Background: Esophageal dysmotility may be the cause or a secondary effect of gastric acid-dependent diseases: erosive reflux disease (ERD), Schatzki ring (SR) and eosinophilic esophagitis (EoE). Methods: This study aims to compare concomitant dysphagia with ERD, SR and EoE, considering manometric patterns, their role in the natural history and their impact on assessing quality of life. Fifty-eight patients with dysphagia underwent high-resolution manometry and esophago-gastro-duodenoscopy (EGD) with an assessment of SR, ERD and sampling for EoE, completed a questionnaire with the Eating Assessment Tool (EAT-10) and the Gastrointestinal Quality of Life Index. Based on endoscopic images and the histopathological criterion of EoE (≥15 eosinophils/high-power field), patients were assigned to groups with ERD, EoE, SR and with normal endoscopic and histopathological images. In the data analysis, p ≤ 0.05 was considered statistically significant. This trial was registered with ClinicalTrials.gov (no. NCT04803162). Results: Both EoE, SR and ERD correlate with ineffective motility. In ERD, normal peristalsis precedes the development of the disease, unlike EoE, which develops later and leads to absent contractility. The development of SR is associated with disorders of the upper esophageal sphincter (UES). In the group with SR and ERD, UES insufficiency significantly reduces the quality of life. Patients with normal esophagus in EGD scored the lowest quality of life and those with SR had the most severe dysphagia. Conclusion: The esophageal motility disorders co-occurring with endoscopic and histological anomalies do not significantly affect the severity of dysphagia, however, in the case of patients with ERD and SR and concomitant UES insufficiency, this motor dysfunction has a significant impact on the reduction in the patients’ quality of life. Although no specific esophageal motility pattern typical of EoE, ERD and SR has been identified, comparative assessment of manometric features may have a potential role in differential diagnosis.

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How to Cope with Big Data in Functional Analysis of the Esophagus

Visceral Medicine ◽

10.1159/000511931 ◽

2020 ◽

Vol 36 (6) ◽

pp. 439-442

Author(s):

Alissa Jell ◽

Christina Kuttler ◽

Daniel Ostler ◽

Norbert Hüser

Keyword(s):

Esophageal Motility ◽

Learning Algorithm ◽

Supervised Machine Learning ◽

Esophageal Motility Disorders ◽

Motility Disorders ◽

High Resolution Manometry ◽

Evaluation Time ◽

Core Evaluation

Introduction: Esophageal motility disorders have a severe impact on patients’ quality of life. While high-resolution manometry (HRM) is the gold standard in the diagnosis of esophageal motility disorders, intermittently occurring muscular deficiencies often remain undiscovered if they do not lead to an intense level of discomfort or cause suffering in patients. Ambulatory long-term HRM allows us to study the circadian (dys)function of the esophagus in a unique way. With the prolonged examination period of 24 h, however, there is an immense increase in data which requires personnel and time for evaluation not available in clinical routine. Artificial intelligence (AI) might contribute here by performing an autonomous analysis. Methods: On the basis of 40 previously performed and manually tagged long-term HRM in patients with suspected temporary esophageal motility disorders, we implemented a supervised machine learning algorithm for automated swallow detection and classification. Results: For a set of 24 h of long-term HRM by means of this algorithm, the evaluation time could be reduced from 3 days to a core evaluation time of 11 min for automated swallow detection and clustering plus an additional 10–20 min of evaluation time, depending on the complexity and diversity of motility disorders in the examined patient. In 12.5% of patients with suggested esophageal motility disorders, AI-enabled long-term HRM was able to reveal new and relevant findings for subsequent therapy. Conclusion: This new approach paves the way to the clinical use of long-term HRM in patients with temporary esophageal motility disorders and might serve as an ideal and clinically relevant application of AI.

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Bread and barium: Diagnostic value in patients with suspected primary esophageal motility disorders

Acta Radiologica ◽

10.1080/028418500127345163 ◽

2000 ◽

Vol 41 (2) ◽

pp. 145-150 ◽

Cited By ~ 10

Author(s):

H. Nellemann ◽

K. Aksglaede ◽

P. Funch-Jensen ◽

P. Thommesen

Keyword(s):

Esophageal Motility ◽

Diagnostic Value ◽

Clinical Suspicion ◽

Esophageal Motility Disorders ◽

Barium Swallow ◽

Motility Disorders ◽

Esophageal Rings ◽

Primary Esophageal Motility Disorders ◽

Diagnostic Step ◽

Infusion System

Purpose: To evaluate the significance of bread and barium studies as a diagnostic tool as well as a supplement to manometric investigation of the esophagus in patients with suspected esophageal motility disorders. Material and Methods: Eighty-nine patients suspected for primary esophageal motility disorders were examined. All patients were interviewed before the investigation to determine the prevalence of symptoms like heartburn, chest pain, and dysphagia. The patients underwent simultaneous roentgenologic and manometric investigations in the supine position during wet and solid barium swallow, and during continuous drinking, followed by investigation for gastroesophageal reflux (GER). The manometric examination was performed with triple-lumen catheters connected to a hydraulic capillary infusion system and external transducers. Results: All patients with normal esophageal clearing (n=31) had normal manometry. Patients with delayed esophageal clearing (n=58) required manometry for identifying concommittant motility disorders; achalasia and diffuse esophageal spasms were found only in patients with delayed liquid and solid emptying. GER and/or esophageal rings was demonstrated in 31 patients. Conclusion: We suggest bread and barium as the first diagnostic step in patients with clinical suspicion of primary esophageal motility disorders.

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PS01.013: CLINICAL SIGNIFICANCE OF ESOPHAGOGASTRODUODENOSCOPY IN PATIENTS WITH ESOPHAGEAL MOTILITY DISORDERS

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.013 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 53-54

Author(s):

Noriaki Manabe ◽

Ken Haruma ◽

Rui Nakato ◽

Jun Nakamura ◽

Takahisa Murao ◽

...

Keyword(s):

Clinical Significance ◽

Esophageal Motility ◽

Esophagogastric Junction ◽

Conflicts Of Interest ◽

Esophageal Motility Disorders ◽

Motility Disorders ◽

High Resolution Manometry ◽

Esophageal Lumen ◽

Chicago Classification ◽

Detection Ratio

Abstract Background Although dysphagia is an indication for esophagogastroduodenoscopy (EGD) its causes include organic and non-organic disorders. There has been no study to investigate the clinical significance of EGD in patients with esophageal motility disorders (EMD). The first aim was to elucidate the detection ratio for EMD with EGD. The second aim was to clarify useful EGD parameters associated with them. Methods Participants included 372 patients who underwent EGD before high resolution manometry for dysphagia. EGD findings were investigated according to the following five parameters: resistance when passing through the esophagogastric junction (EGJ), residue in the esophageal lumen, esophageal dilation, spastic and non-occlusive contraction. The EGD finding was positive when at least one EGD finding was detected. HRM diagnoses were made based on the Chicago classification (v3.0). Results Of 372 participants, pseudoachalasia were diagnosed in 6 patients (1.61%), EMD in 250, and normal in 116. The detection ratio for each EMD by EGD is shown in Table 1. There were significant differences in the detection ratio among the three groups (81.1% in major, 50.0% in minor EMD and 15.5% in normal, P < 0.05). On multivariate analysis, resistance when passing through the EGJ (adjusted odds ratio (aOR): 3.99; 95% CI [1.26–12.66]), and non-occlusive contraction (aOR: 10.3; 95% CI [5.26–20.19]) were significantly associated with EMD. Conclusion The ratio of abnormal EGD findings was different in each EMD. Major EMD can be screened with EGD. Among several endoscopic parameters related with EMD, the non-occlusive contraction is most useful endoscopic parameter. Disclosure All authors have declared no conflicts of interest.

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PS01.049: ENDOSTIM™ NON-RESPONDERS: AN ANALYSIS

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.049 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 63-64

Author(s):

Florian Matthias Corvinus ◽

Edin Hadzijusufovic ◽

Benjamin Babic ◽

Hauke Lang ◽

Peter Grimminger

Keyword(s):

Quality Of Life ◽

Hiatal Hernia ◽

Conflicts Of Interest ◽

Symptom Relief ◽

Symptom Control ◽

Long Term Results ◽

Barium Swallow ◽

Technical Failure ◽

Postoperative Reflux

Abstract Background Electronic stimulation oft the lower esophageal sphincter (LES) is a new promising anti-reflux procedure that is established in Germany since 2014. Basically two leads are inserted laparoscopicaly into the LES and connected to an implantable pulse generator (IPG) which is placed in a subcutaneous pocket. This stimulation is supposed to build up the muscular anti-reflux barrier. It is limited to patients with a small hiatal hernia < 3 cm and reflux esophagitis LA Classification Type A-C. Although long-term results up to 4 years with a good postoperative reflux control and an increased quality of life have been published, no data about Endostim™ non-responders, difficult postoperative situations and procedure failure has been reported yet. Methods Between 12/2015 and 11/2017 12 patients underwent laparoscopy for an Endostim™ implantation. All patients had an upper endoscopy, a barium swallow, high-resolution esophageal impedance manomentry (HRIM), 24-hour multi-channel impedance and pH monitoring (MII-pH) prior to the procedure and after 6 months. The quality of life was assessed with the GERD health related quality of life (GERD-HRQL) questionnaire preoperatively and during further follow-up. Results 6 of 12 patients (50%), 2 female 4 male, reported new GERD symptoms after an initial postoperative symptom relief. 1 patient had a prolonged period (15 months) of reprogramming until complete symptom control was achieved. 1 patient had a recurrent 3 cm hiatal hernia after 3 months, so that only a partial responds was reported. In 2 patients reprogramming could not reach a proper responds. Two patients showed a complete technical failure due to a broken lead close to the IPG. Conclusion Reasons for Endostim™ failure can be heterogeneous. Because it is a young and new procedure non-responders should be investigated closely so that there can be a critical discussion about indications, contraindications and negative predictive factors. Disclosure All authors have declared no conflicts of interest.

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