Distensibility index measured after Toupet fundoplication is associated with long-term dysphagia

Background: The endoluminal functional lumen imaging probe (EndoFLIP) provides objective data during Toupet fundoplication. However, it remains unknown whether the values obtained during surgery are associated with long-term dysphagia. Methods: We performed a retrospective cohort analysis of patients who underwent Toupet fundoplication with or without hiatal hernia repair between 2017 and 2022 at a single institution. The distensibility index (DI) was recorded with 30 mL in the catheter after fundoplication. The patients were divided into three groups: Group 1 (DI < 1.5), Group 2 (DI 1.5–2.0), and Group 3 (DI > 2.0). We then analyzed the rates of dysphagia one year after surgery among the groups. Results: A total of 395 patients (median age, 67 years) were predominantly female (69%, n = 273) and mostly white (85%, n = 336). At 5 weeks post-surgery, all groups showed significant improvement in GERD, dysphagia, and bloating symptoms. In patients with a DI between 1.5 and 2, proton pump inhibitor use was significantly less than that in the other groups. At 1 year, dysphagia was significantly higher in the DI < 1.5 group (8.7%, n = 13/150) than in the DI > 2 group (2.7%, n = 4/146, p = 0.04). Multivariate analysis showed that DI < 1.5 was an independent factor associated with long-term dysphagia. Conclusion: Patients with a distensibility index of < 1.5 were associated with a significantly higher rate of dysphagia at one year. EndoFLIP provides objective data during surgery, which may help predict long-term outcomes of dysphagia. Patients undergoing Toupet fundoplication may benefit from a final DI > 1.5.