Absence of Contraction Reserve Does Not Predict Late Post-Operative Dysphagia Following Anti-Reflux Surgery

Background Early post-operative dysphagia (POD) is a frequent complication of anti-reflux surgery (ARS). Although it often improves, late dysphagia may persist. Certain esophageal manometry metrics have been proposed to preoperatively predict late POD. Some prior studies show that a particular metric, i.e., lack of Contraction Reserve, predicts late POD. This has been considered but not implemented in recent international guidelines, and consensus remains that further studies are required to confirm the correlation. We present here the first Australian case series to examine the relationship between contraction reserve and dysphagia after ARS, as well as examining other relevant manometric relationships. Methods All patients from a single institution who underwent ARS between 2011 and 2021 were included if both preoperative high-resolution manometry (HRM) and postoperative symptoms questionnaires (Visick score, GERD-HRQL and Eckhardt score) had been obtained. HRM was assessed using the Medtronic Manoscan system and used a standardised protocol including provocation testing with MRS. The DCI ratio of MRS:SS was calculated. Various other ratios were calculated, examining the relationship between such factors as maximum or minimum MRS amplitude, maximum or minimum SS amplitude and mean DCI of MRS and SS. The results were analysed using the statistics software Stata. Results 36 patients were included. Excellent post-operative outcomes with minimal POD was observed, with low scores on questionnaires: Visick (mean 1.86, maximum possible score (MPS) 4), GERD-HQRL (mean 4.97, MPS 50) and Eckhardt (mean 0.89, MPS 12). Mean age was 70.6 years. Median follow-up was 4.69 years. Only 4 patients (11.1%) had DCI MRS:SS ratio > 1. Contraction reserve had an inverse correlation with Visick scores (r = −0.18, p = 0.513,) and a weak positive correlation with Eckhardt scores (r = 0.11, p = 0.713, Fig. 1), but neither result was statistically significant. No further significant relationships were observed between other parameters and dysphagia. Conclusion This is the first Australian study to examine the relationship between contraction reserve and postoperative dysphagia. We found that lack of contraction reserve (defined as the DCI MRS:SS ratio < 1 on pre-operative manometry) was not predictive of late post-operative dysphagia. Further studies with larger sample sizes are needed to further examine if contraction reserve, or other parameters from HRM, predict post-ARS dysphagia, before such metrics should be included in future guidelines.