| The principal area of research towards a Masters degree has been to evaluate the role of oesophageal manometry in the pre-operative assessment of patients with gastro-oesophageal relux disease (GORD). It is well recognised that a significant proportion of reflux patients experience non-obtrusive dysphagia, and a similar proportion are found to have poor oesophageal motility on manometric testing. Many surgeons consider the two features related and also believe that by the same mechanism post-fundoplication non-obtrusive dysphagia is attributable to poor pre-operative oesophageal motility. The demonstration of poor pre-operative oesophageal contractile function with manometry is therefore used by many clinicians to tailor anti-reflux surgery so as to reduce the risk of post-fundoplication dysphagia. The use of manometry in such a context is, however, controversial as there is no consistent or convincing evidence to support the relationship between poor oesophageal motility and symptoms of non-obstructive dysphagia, either pre-operatively or post-operatively. One possible reason may be that standard oesophageal manometry is an inappropirate method of assessing oesophageal motility in GORD.
The research undertaken prospectively compares three methods of manometry (i.e. standard, provocative and 24-hour ambulatroy) on controls and pre-operative reflux patients to pre-operative non-obstructive dysphagia. The findings to date show no significant association between poor oesophageal motility and non-obstructive dysphagia, irrrespective of the methods of manometry. The impending conclusion is that oesophageal manometry fails to predict which patients experience pre-operative non-obstructive dysphagia. This raises further doubt as to the value of oesphageal manometry in deciding which patients with distaloesphageal tumours, and to what extent this contributes to malignant dysphagia, and the use of endoscopic argon beam coagulation to ablate Barrett's oesophagus.
PUBLICATIONS
Finch JG, Fosh BG, Anthony AA, Texler M, Pearson S, Dennison AR, Maddern GJ. The use of a liquid electrode in hepatic electrolysis. Journal of Surgical Research 2004; 120(2):272-277.
Sutherland LM, Middleton PF, Anthony A, Hamdorf J, Cregan P, Scott D, Maddern GJ. Surgical simulation. A systematic review. Annals of Surgery 2006; 243(2):291-300 |
