OC-068 Structure and function of the gastro-oesophageal junction in patients after laparoscopic fundoplication: concurrent magnetic resonance imaging and high-resolution manometry studies

IntroductionLaparoscopic fundoplication provides effective reflux control in patients with gastro-oesophageal reflux disease (GERD); however a proportion of patients that undergo surgery experience troublesome symptoms. Improved results may be possible if more was known about the structural factors that effect treatment outcome.This study applied concurrent MRI and HRM technology to compare the structure and function of the GEJ in GERD patients after fundoplication to control groups of GERD patients and healthy participants (HPs).MethodsEight GERD patients were studied at least 3 months after laparoscopic fundoplication with subjectively good treatment outcome (7M, age 18–67 years). Results of pH-impedance monitoring off acid suppression before and after fundoplication were available. 12 patients with GERD on medical therapy (7M, age 20–55 years) and 12 HPs (7M, age 26–36 years) with no history of gastro-intestinal disease or surgery. Validated MRI measurements of the oesophago-gastric insertion angle (Radiology in press) and gastric volumes were performed at baseline and after ingestion of high calorie meal (McDonalds Cheeseburger, Chips, Milkshake, 735 kcal). Visual Analogue Scales (100 mm VAS) documented dyspeptic symptoms.ResultsGEJ pressure increased from before to after fundoplication (8.3±1.2 vs 14.2±1.7 mm Hg, p=0.03) whereas acid exposure (10.3±2.2 vs 5.4±2.1, p=0.001) and reflux episodes reduced (39±3 vs 24±2, p=0.019). The insertion angle after the meal was more obtuse after surgery than in the disease and healthy controls (61° vs 48° vs 41°, p