S. Purnell1, D. Nguyen2, E. Y. Chan1, R. Chihara1, E. A. Graviss2, M. P. Kim1 1Houston Methodist Hospital, Thoracic Surgery, Houston, TX, USA 2Houston Methodist Hospital, Pathology And Genomic Medicine, Houston, TX, USA
Introduction: Magnetic sphincter augmentation or LINX provides a barrier between the esophagus and stomach to treat patients with symptomatic gastroesophageal reflux (GERD) with or without hiatal hernia. Endoscopic functional lumen imaging probe (EndoFLIP) measures changes in esophageal volume and pressure to calculate distensibility index (DI), which can help tailor closure of the crus and provide final objective measurement after placement of LINX. The aim of our study was to examine the relationship between EndoFLIP measurements and post-operative outcomes in patient that underwent LINX procedure. We hypothesized that the final DI would correlate with dysphagia after surgery.
Methods: We performed retrospective analysis of prospectively collected data on consecutive patients who underwent LINX from 2017-2021. We excluded patient who did not have completed preoperative and postoperative GERD health-related quality of life (GERD-HRQL) assessment. We then analyzed the overall GERD-HRQL score, dysphagia score and bloat score before and after the surgery. We performed Pearson’s correlation test to determine the correlation between dysphagia and final distensibility index (DI) after LINX. We also used the generalized linear model (GLM) to determine the characteristics associated with dysphagia score.
Results: There were 117 patients who underwent a LINX procedure during the time period and 91 patients met the criteria. The median age of the cohort was 60 with majority of the patients being female (71.4%), white (92.3%), and with type I hiatal hernia (56.7%). The final median DI after LINX placement was 1.5 with IQR (1.1, 1.8) with 30 cc in the 8 cm EndoFLIP balloon. There was a significant decrease in the GERD-HRQL score (0-50 scale) from 21.4 to 5.9 (p<0.001) and bloat score (0-5 scale) from 2.6 to 1.8 (p=0.03), but there was no significant difference in dysphagia score (0-5 scale) from 1.7 to 1.4 (p=0.34) before and after placement of the LINX. Pearson’s correlation test showed no correlation between dysphagia and final DI after LINX placement (p=0.69). The GLM analysis suggested that only factor significantly associated with increased dysphagia was younger age (p=0.02).
Conclusion: There was no correlation between final DI after placement of the LINX device and dysphagia score. This could be due to low rates of significant dysphagia in the group with keeping DI after closure of crus > 0.5. Further studies are needed to elucidate the correlation between the DI and dysphagia.