Preoperative esophageal transit studies are a useful predictor of dysphagia after fundoplication

Fundoplication performed for gastroesophageal reflux disease may be complic ated by postoperative dysphagia despite successful reduction in reflux symp toms. This is more likely in those patients with reflux who have concurrent esophageal dysmotility. The aim of this study was to establish whether eso phageal transit studies using a technetium-99m jello bolus (jello esophagea l transit) could detect the presence of motility disorders preoperatively a nd hence predict surgical outcome. Transit studies in 33 healthy volunteers yielded a normal range of 2 to 24 seconds using ninety-fifth percentile di stribution. In the second phase of the study, 26 patients accepted for lapa roscopic fundoplication were enrolled: jello esophageal transit, manometry, and endoscopy were attempted preoperatively in all subjects. A clinical dy sphagia score was assigned from a questionnaire. Six months after surgery, five patients had dysphagia and of these four were found to have abnormal p reoperative jello esophageal transit, for a sensitivity of 80%. Of the 21 p atients who had no dysphagia after surgery:, 20 patients had normal preoper ative jello esophageal transit, showing a specificity of 95%. This esophage al transit study is noninvasive, reliable, and sensitive. When performed pr ior to fundoplication, it appears to be of significant value in detecting a subtle functional motility disorder that predisposes to postoperative dysp hagia. Jello esophageal transit may assist the surgeon in planning treatmen t of gastroesophageal reflux disease.