Bolus exposure as a novel predictor of postoperative symptom resolution after laparoscopic nissen fundoplication: A two-institutional retrospective cohort study.
Suh Woo Jung, Inhyeok Lee, In Yeong Lee, Jeong Woo Kim, Ahmad Alromi, Won Jun Seo, Shin-Hoo Park, Yeongkeun Kwon, You-Jin Jang, Chang Min Lee, Jong-Han Kim, Joong-Min Park, Sungsoo Park
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引用次数: 0
Abstract
Background: Even in the absence of definite evidence of pathological acid reflux, antireflux surgery (ARS) can still effectively improve gastroesophageal reflux symptoms. Nonetheless, predicting postoperative reflux symptom improvement has been primarily dependent on acid-based parameters. No objective index reflecting both acid and non-acid reflux was identified to select ARS candidates.
Materials and methods: Prospectively collected data of 121 patients with gastroesophageal reflux disease (GERD), who underwent laparoscopic Nissen fundoplication from two institutions, were retrospectively reviewed. The patients reported preoperative and postoperative GERD symptoms using the Korean version of the GERD questionnaire, along with the gastroesophageal reflux disease-health-related quality of life (GERD-HRQL). The patients assessed for reflux symptoms using bolus exposure, acid exposure time (AET), and DeMeester score (DMS) as measurements were selected. For each reflux parameter, its association, correlation, and predictive capacity of the degree of postoperative symptom resolution were analyzed using chi-squared tests, point-biserial correlations, logistic regression analyses, and receiver operating characteristic curve analyses.
Results: 72 patients were eligible for this study. Bolus exposure was superior to the other parameters in terms of the degree of association and correlation with resolution of typical symptoms. Bolus exposure also showed a higher diagnostic accuracy in predicting the resolution of epigastric pain (area under the curve [AUC]=0.723, P=0.013) and regurgitation (AUC=0.981, P<0.001). Secondary analyses were performed in patients without pathological reflux, defined as the DMS-negative (DMS<14.7) or AET-negative (AET<6%) groups. In the secondary analyses, bolus exposure showed considerable diagnostic accuracy with statistical significance for all typical symptoms in both in the DMS-negative (heartburn: AUC=0.717, P=0.025; epigastric pain: AUC=0.717, P=0.025; regurgitation: AUC=0.975, P<0.001) and AET-negative (heartburn: AUC=0.681, P=0.045; epigastric pain: AUC=0.749, P=0.009; regurgitation: AUC=0.975, P<0.001) groups.
Conclusion: Bolus exposure, a parameter of total reflux, was superior to AET or DMS in defining candidates for ARS. Further studies investigating the surgical indications for ARS in patients with non-acid reflux using bolus exposure are required.
背景:即使没有明确的病理性胃酸反流证据,抗反流手术(ARS)仍能有效改善胃食管反流症状。然而,预测术后反流症状的改善主要依赖于以酸为基础的参数。目前还没有找到同时反映酸性和非酸性反流的客观指标来筛选 ARS 候选者:回顾性分析了两家医疗机构前瞻性收集的121名接受腹腔镜尼森胃底折叠术的胃食管反流病(GERD)患者的数据。患者使用韩国版胃食管反流病问卷报告了术前和术后的胃食管反流病症状,同时还报告了胃食管反流病-健康相关生活质量(GERD-HRQL)。选择使用栓剂暴露、酸暴露时间(AET)和 DeMeester 评分(DMS)作为反流症状评估指标的患者。通过卡方检验、点-双向相关性、逻辑回归分析和接收器操作特征曲线分析,分析了每个反流参数的关联性、相关性和对术后症状缓解程度的预测能力:72名患者符合研究条件。就与典型症状缓解的关联度和相关性而言,栓剂暴露优于其他参数。在预测上腹痛(曲线下面积 [AUC]=0.723,P=0.013)和反胃(AUC=0.981,P=0.013)的缓解方面,博乐暴露也显示出更高的诊断准确性:在确定 ARS 候选者方面,作为全反流参数的 Bolus exposure 优于 AET 或 DMS。需要进一步研究使用栓子暴露对非酸性反流患者进行 ARS 的手术适应症。
期刊介绍:
The International Journal of Surgery (IJS) has a broad scope, encompassing all surgical specialties. Its primary objective is to facilitate the exchange of crucial ideas and lines of thought between and across these specialties.By doing so, the journal aims to counter the growing trend of increasing sub-specialization, which can result in "tunnel-vision" and the isolation of significant surgical advancements within specific specialties.