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BACKGROUND: Esophageal manometry is considered the gold standard for evaluating esophageal motor function prior to fundoplication. This is an uncomfortable, invasive procedure with study results variably affected by technician experience and patient tolerance. The aim of this study was to evaluate the relative efficacy of esophageal transit nuclear scintigraphy (ETS) and esophageal manometry in assessing esophageal motility among GERD patients with typical reflux symptoms.
METHODS: We reviewed the preoperative evaluation of 82 patients undergoing fundoplication for medically recalcitrant typical GERD. Esophageal manometry and ETS were preformed in all patients to assess esophageal motor function. Barium esophagrams and upper endoscopy were also performed universally. ETS was considered abnormal if radionucleotide retention within the esophagus was greater than 5% at 1 minute or greater than 3% at 5 and 10 minutes. Chi square and Fisher’s exact tests were used for statistical analysis.
RESULTS: Using the esophageal manometry as the benchmark, the relative sensitivity, specificity and predictive values of preoperative ETS were identified. (See Table).
CONCLUSIONS: Esophageal transit nuclear studies have a predictive value of 90% in determining normal esophageal motility among medically recalcitrant GERD patients with typical symptoms. ETS may be used as the sole esophageal motor function evaluation prior to fundoplication when a normal ETS result is found. When ETS is abnormal, manometric evaluation should be utilized prior to fundoplication to characterize esophageal motor function.