MARSHMALLOW-BAGEL UPPER GASTROINTESTINAL STUDY IN PARAESOPHAGEAL HERNIA PATIENTS

Abstract

The traditional method used to evaluate esophagus and foregut functions prior to surgical treatment is esophageal manometry. Esophageal manometry is the insertion of a pressure sensitive catheter through the nose into the esophagus. During an esophageal manometry, the patient is asked to perform swallowing maneuvers. The esophageal manometry provides information on the status of esophageal muscle function, coordination, and contraction. The results establish which anti-reflux technique the esophageal musculature can tolerate. Many patients show difficulty swallowing with the esophageal manometry technique. An alternative method for monitoring esophageal muscle movement is to have the patient swallow a barium-soaked marshmallow followed by a barium-soaked bagel portion. When the patient swallows the items, the surgeon tracks the movement through the gastroesophageal junction. The ability to swallow the portions indicates to the surgical team that the patient can tolerate the anti-reflux surgery. The surgical outcomes following patients who undergo the marshmallow-bagel study in comparison to those who complete the full esophageal manometry were analyzed for significant differences. The null hypothesis is that patients receiving the esophageal manometry and patients receiving the marshmallow and bagel show no difference in outcome regarding the ability to swallow, toleration a regular diet, presence of dysphagia, presence of odynophagia, need for postoperative steroids, and need for esophageal dilation. Two patient groups were divided by the charts of patients who underwent preoperative procedures for a paraesophageal hernia repair. The first population included patients who only received the marshmallow-bagel technique before surgical treatment. The second population included patients who only received an esophageal manometry before surgical intervention.