Management of Functional Esophagogastric Junction Outflow Obstruction: A Systematic Review.

Published

Conference Paper

GOALS:Awareness of functional esophagogastric junction outflow obstruction (fEGJOO) has increased, but because there is no consensus on its management, we performed a systematic review of the literature to explore treatment strategies and outcomes. BACKGROUND:EGJOO is a heterogenous disorder defined by high-resolution manometry parameters of elevated integrated relaxation pressure with preserved esophageal peristalsis. The etiology may be mechanical obstruction or idiopathic, the latter being fEGJOO. STUDY:The PubMed/MEDLINE, Embase, and the Cochrane library electronic databases were searched through June 2018 for all studies of adult patients describing a treatment strategy for fEGJOO or incomplete lower esophageal sphincter relaxation. The search strategy yielded 1792 studies and 8 (0.4%) met inclusion criteria. RESULTS:All but one included studies were retrospective (n=184 patients). There were 5 interventions described, with botulinum toxin (Botox) injection (n=69) and expectant management (n=82) the most frequently reported, with success rates of 58% and 54%, respectively. There was substantial heterogeneity among patients and treatments were not directly compared, though reported symptom resolution was similar among all strategies with a mean follow-up time of 15 months. CONCLUSIONS:There are a variety of management strategies available for fEGJOO and some patients may not require any intervention. However, among 4 potential approaches aimed at disrupting lower esophageal sphincter hypertonicity, the largest existing evidence base supports either a therapeutic challenge of Botox injection or watchful waiting. Ultimately, these data indicate the need for further study with controlled trials to identify a definitive approach.

Full Text

Duke Authors

Cited Authors

  • Garbarino, S; von Isenburg, M; Fisher, DA; Leiman, DA

Published Date

  • December 19, 2018

Published In

PubMed ID

  • 30575636

Pubmed Central ID

  • 30575636

Electronic International Standard Serial Number (EISSN)

  • 1539-2031

International Standard Serial Number (ISSN)

  • 0192-0790

Digital Object Identifier (DOI)

  • 10.1097/mcg.0000000000001156