The Benefits of Nonablative Radiofrequency Treatment of the Lower Esophageal Sphincter After Transoral Incisionless Fundoplication

2020 ◽  
Vol 86 (11) ◽  
pp. 1525-1527
Author(s):  
Medhat Fanous ◽  
Anja Jaehne ◽  
Jenna Simbob
Keyword(s):  
Hiatal Hernia ◽  
Lower Esophageal Sphincter ◽  
Transoral Incisionless Fundoplication ◽  
Gradual Improvement ◽  
Hrql Score ◽  
Demeester Score ◽  
Radiofrequency Treatment ◽  
Patient Reported ◽  
Sliding Hiatal Hernia ◽  
Esophageal Sphincter

Non-ablative radiofrequency treatment to the lower esophageal sphincter (Stretta) has been shown to be beneficial after failed Nissen fundoplication. To our knowledge, this is the first report of Stretta after transoral incisionless fundoplication (TIF). This patient is a 17-year-old female who had gastroesophageal reflux disease (GERD) symptoms for 9 years. She presented with heartburn, regurgitation, and epigastric discomfort. She used omeprazole for 9 years. Esophagogastroduodenoscopy (EGD) showed a 2 cm sliding hiatal hernia and DeMeester score of 25. The GERD Health-Related Quality of Life (GERD-HRQL) score on omeprazole was 14. Patient underwent a TIF procedure, which was uneventful. Her symptoms resolved, and she discontinued omeprazole. Six months later, she had episodes of repeated violent vomiting followed by recurrence of regurgitation, nausea, bloating, and dysphagia. She resumed omeprazole. Diagnostic workup included gastric emptying scan, which was normal. EGD showed no hiatal hernia and partial disruption of the TIF valve. DeMeester score was 36.3. Esophageal manometry with impedance showed intact peristalsis and normal relaxation of the lower esophageal sphincter. The patient underwent Stretta, which was uneventful. The previous TIF did not increase the complexity of the procedure. There were no immediate or postoperative complications. The patient reported gradual improvement of her symptoms with complete resolution 2 months postoperatively. She discontinued omeprazole. The GERD-HRQL score 17 months post-Stretta was 0. This case highlights the feasibility, safety, and efficacy of performing Stretta following TIF. It provides an endoluminal alternative to complex revisional antireflux surgery. Prospective studies with longer follow-up are required to validate this concept.

PS01.008: LOWER ESOPHAGEAL SPHINCTER PRESSURE (LESP) AS A MEASURE OF ANTI-REFLUX BARRIER IN PATIENTS WITH HIATUS HERNIA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 51-52
Author(s):  
Balazs Kovacs ◽  
Takahiro Masuda ◽  
Ross Bremner ◽  
Sumeet Mittal
Keyword(s):  
Hiatal Hernia ◽  
Lower Esophageal Sphincter ◽  
Hiatus Hernia ◽  
Conflicts Of Interest ◽  
Holding Time ◽  
Sphincter Pressure ◽  
Total Acid ◽  
Inversion Point ◽  
Type C ◽  
Esophageal Sphincter

Abstract Background Hiatus Hernia (HH), with its anatomical/physiological derangement of esophagogastric junction (EGJ) barrier function is a risk factor for pathological gastro-esophageal reflux (GER). However, a subset of patients with HH do not have reflux. The aim of this study is to explore Lower Esophageal sphincter parameters and GER across the EGJ in patients with manometeric type C hiatal hernia (LES-Crural Diaphragm separation > 1cm, and Pressure Inversion Point below LES). Methods An IRB approved, prospectively maintained esophageal testing registry was queried to identify patients who underwent High Resolution Manometry and 24h pH study (within 1 week) between 11/01/2016 and 11/01/2017. HRM characteristics of the EGJ (LES-CD separation, overall length, LESP, LESPI), 24 hour pH score, and pH < 4 holding time were extracted. Spearman's Rho correlation was calculated for all parameters and Receiver operating characteristic (ROC) curve was applied for parameters with significant correlation. Results A total of 1139 patients underwent HRM during the study period, of these 416 also had 24 hour pH study. 76 Patients met criteria for EGJ morphology Type C. After excluding patients with major disorders of peristalsis (16) the remaining 60 patients form the cohort of this study. Hiatal hernia size, overall length of LES, and LESPI did not correlate with 24 hour pH score or pH < 4 holding time. LESP had a significant negative correlation both with 24 hour pH score (R: -0.322; P = 0.011), and total acid holding time (R: -0.348; P = 0.006). A LESP cut-off value of 24.4 mmHg had a sensitivity of 53.8% and a Specificity of 91.2% for predicting pathological reflux. Conclusion A higher LESP (> 24.4 mmHg) appears to provide an effective barrier to pathological GER even when normal EGJ function is compromised by a hiatal hernia. Disclosure All authors have declared no conflicts of interest.

scholarly journals 747 – Impact of Hiatal Hernia Status on Manometric Characteristics of the Lower Esophageal Sphincter (LES) and Esophageal Body Function

2019 ◽  
Vol 156 (6) ◽  
pp. S-1412
Author(s):  
Shahin Ayazi ◽  
Ali H. Zaidi ◽  
Ping Zheng ◽  
Kristy L. Chovanec ◽  
Madison Salvitti ◽  
...  
Keyword(s):  
Hiatal Hernia ◽  
Lower Esophageal Sphincter ◽  
Esophageal Body ◽  
Body Function ◽  
Esophageal Sphincter

The Importance of Hiatal Hernia in Reflux Esophagitis Compared with Lower Esophageal Sphincter Pressure or Smoking

1991 ◽  
Vol 13 (6) ◽  
pp. 628-643 ◽  
Author(s):  
Stephen J. Sontag ◽  
Thomas G. Schnell ◽  
Todd Q. Miller ◽  
Bernard Nemchausky ◽  
Rose Serlovsky ◽  
...  
Keyword(s):  
Hiatal Hernia ◽  
Lower Esophageal Sphincter ◽  
Reflux Esophagitis ◽  
Lower Esophageal Sphincter Pressure ◽  
Sphincter Pressure ◽  
Esophageal Sphincter

Trans-Oral Incisionless Fundoplication (TIF): How I Do It and Why

2021 ◽  
pp. 263451612110249
Author(s):  
Kenneth J. Chang
Keyword(s):  
Hernia Repair ◽  
Lower Esophageal Sphincter ◽  
Treatment Option ◽  
Structure And Function ◽  
Transoral Incisionless Fundoplication ◽  
Standardized Protocol ◽  
Esophageal Sphincter ◽  
And Function ◽  
Flap Valve

Transoral Incisionless Fundoplication (TIF) is designed to create a 3 cm length, 270° to 300°, omega-shaped flap valve, reconstructing the structure and function of the lower esophageal sphincter (LES), including the gastric sling fibers. As such, TIF is a treatment option for GERD patients with an intact crura, but have lost the integrity and function of the LES. In patients requiring a hernia repair, TIF can be used concomitantly (cTIF). While there are a number of steps to the TIF 2.0 procedure, many of the sequences are repetitive and follow a standardized protocol, optimizing efficiency, safety, and scalability.

Drs. Darling and Gellis Reply

PEDIATRICS ◽  
1975 ◽  
Vol 56 (4) ◽  
pp. 614-614
Author(s):  
Donald B. Darling ◽  
Sydney S. Gellis
Keyword(s):  
United Kingdom ◽  
Gastroesophageal Reflux ◽  
Hiatal Hernia ◽  
Lower Esophageal Sphincter ◽  
North American ◽  
True Incidence ◽  
The United Kingdom ◽  
Esophageal Sphincter ◽  
American Children

Although our initial concern was to determine the true incidence of hiatal hernia in North American children relative to that reported from the United Kingdom and Europe, it became increasingly clear that the basic cause of symptoms in children (as well as in adults) was abnormal gastroesophageal reflux due to incompetence of the lower esophageal sphincter (LES) with or without demonstrable hernia, and Dr. Mones should have had no difficulty noting this in the paper.

Hiatal hernia size affects lower esophageal sphincter function, esophageal acid exposure, and the degree of mucosal injury

1996 ◽  
Vol 171 (1) ◽  
pp. 182-186 ◽  
Author(s):  
Marco G. Patti ◽  
Henry I. Goldberg ◽  
Massimo Arcerito ◽  
Luca Bortolasi ◽  
Jenny Tong ◽  
...  
Keyword(s):  
Hiatal Hernia ◽  
Lower Esophageal Sphincter ◽  
Mucosal Injury ◽  
Esophageal Acid Exposure ◽  
Acid Exposure ◽  
Sphincter Function ◽  
Esophageal Sphincter ◽  
Hernia Size
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