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Background <p>The endoluminal functional lumen imaging probe (EndoFLIP) provides objective data during Toupet fundoplication. However, it remains unknown whether the values obtained during surgery are associated with long-term dysphagia.</p> Methods <p>We performed a retrospective cohort analysis of patients who underwent Toupet fundoplication with or without hiatal hernia repair between 2017 and 2022 at a single institution. The distensibility index (DI) was recorded with 30&#xa0;mL in the catheter after fundoplication. The patients were divided into three groups: Group 1 (DI &lt; 1.5), Group 2 (DI 1.5–2.0), and Group 3 (DI &gt; 2.0). We then analyzed the rates of dysphagia one year after surgery among the groups.</p> Results <p>A total of 395 patients (median age, 67&#xa0;years) were predominantly female (69%, <i>n</i> = 273) and mostly white (85%, <i>n</i> = 336). At 5&#xa0;weeks post-surgery, all groups showed significant improvement in GERD, dysphagia, and bloating symptoms. In patients with a DI between 1.5 and 2, proton pump inhibitor use was significantly less than that in the other groups. At 1&#xa0;year, dysphagia was significantly higher in the DI &lt; 1.5 group (8.7%, <i>n</i> = 13/150) than in the DI &gt; 2 group (2.7%, <i>n</i> = 4/146, <i>p</i> = 0.04). Multivariate analysis showed that DI &lt; 1.5 was an independent factor associated with long-term dysphagia.</p> Conclusion <p>Patients with a distensibility index of &lt; 1.5 were associated with a significantly higher rate of dysphagia at one year. EndoFLIP provides objective data during surgery, which may help predict long-term outcomes of dysphagia. Patients undergoing Toupet fundoplication may benefit from a final DI &gt; 1.5.</p>

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Distensibility index measured after Toupet fundoplication is associated with long-term dysphagia

  • 期刊论文

  • 发表日期：

    2025年6月10日

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  • Min P. Kim,
  • Zoe K. Lichtenberg,
  • Duc T. Nguyen,
  • Warren Naselsky,
  • Edward A. Graviss,
  • Ray Chihara

摘要

Background

The endoluminal functional lumen imaging probe (EndoFLIP) provides objective data during Toupet fundoplication. However, it remains unknown whether the values obtained during surgery are associated with long-term dysphagia.

Methods

We performed a retrospective cohort analysis of patients who underwent Toupet fundoplication with or without hiatal hernia repair between 2017 and 2022 at a single institution. The distensibility index (DI) was recorded with 30 mL in the catheter after fundoplication. The patients were divided into three groups: Group 1 (DI < 1.5), Group 2 (DI 1.5–2.0), and Group 3 (DI > 2.0). We then analyzed the rates of dysphagia one year after surgery among the groups.

Results

A total of 395 patients (median age, 67 years) were predominantly female (69%, n = 273) and mostly white (85%, n = 336). At 5 weeks post-surgery, all groups showed significant improvement in GERD, dysphagia, and bloating symptoms. In patients with a DI between 1.5 and 2, proton pump inhibitor use was significantly less than that in the other groups. At 1 year, dysphagia was significantly higher in the DI < 1.5 group (8.7%, n = 13/150) than in the DI > 2 group (2.7%, n = 4/146, p = 0.04). Multivariate analysis showed that DI < 1.5 was an independent factor associated with long-term dysphagia.

Conclusion

Patients with a distensibility index of < 1.5 were associated with a significantly higher rate of dysphagia at one year. EndoFLIP provides objective data during surgery, which may help predict long-term outcomes of dysphagia. Patients undergoing Toupet fundoplication may benefit from a final DI > 1.5.