Poster (15W148)

Esophagogastric Junction (EGJ) Outflow Obstruction

Author(s)

Yousif K, Barry L, Buckley M

Department(s)/Institutions

Mercy University Hospital

Introduction

EGJ outlfow obstruction is one of the causes of non obstructive dysphagia, characterized by impaired LES relaxation – raised Integrated Resting Pressure (IRP) (>23 mmHg) - with preserved peristalsis. High resolution manometry HRiM is the gold standard of assessing and diagnosing EGJ outflow obstruction. It can co-exist with Distal Oesophageal Spasm DES giving symptoms of dysphagia and chest pain.

Aims/Background

To assess the sensitivity of OGD and Barium swallow in diagnosing EGJ outflow obstruction. To compare response to various treatments: Endoscopic - pneumatic dilatation/Botox - and Heller’s myotomy.

Method

All patients that were diagnosed with EGJ outflow obstruction from February 2013 to March 2015 based on HiRM results –Chicago classification- were included and their medical notes were reviewed retrospectively for presenting symptoms, intervention and outcome. Barium swallow and Gastroscopy results were collected to compare the sensitivity against HiRM.

Results

41 patients were diagnosed with EGJ outflow obstruction. 4 patients were excluded as secondary to antireflux surgery, 3 were lost to follow up and 14% had co-existing Jackhammer Oesophagus. The median age is 57 with standard deviation of 14.7, 62% are females. The median IRP is 21 mmHg, with a mean value of 22.8 and standard deviation of 6.7. Half of the patients had no intervention, 15% had pneumatic dilatation, 20% had Botox, 3% had both –Botox/pneumatic or Botox/ Myotomy - and 12% proceeded to Heller’s Myotomy. ¾ of patients responded positively to pneumatic dilatation, verses 71% for Botox and 100% for Heller’s myotomy. Nevertheless, this is not statistically significant when comparing pneumatic vs Botox (p 0.89) and surgical vs endoscopic intervention (p 0.24). All patients had OGDs and 2/3 had Barium swallow, both have very low sensitivity in the diagnosis of EGJ outflow – 4 and 7% respectively.

Conclusions

EGJ ouflow obstruction presents with dysphagia in all patients, more prevalent in females 2:1. Both Gastroscopy and Barium swallow have very low sensitivity for diagnosis of EGJ ouflow obstruction. Pneumatic dilatation/Botox in addition to Sildenafil is a reasonable approach with variable response. Heller’s myotomy can be used if endoscopic treatment fails.

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