OA09.1. Postoperative High-Resolution Manometry in Clinical Practice: Validation of the Padova Classification

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Abstract Topic Benign Disease: Gastro-Esophageal Reflux and Hiatal Hernia Background The reasons for surgical failure after LF are not fully understood, and identifying predictors of poor outcomes remains an active research area. A postoperative high-resolution manometry (HRM) classification - the Padova Classification - was recently proposed to distinguish defective from functioning fundoplications. This study aimed to validate this new classification. Methods We analyzed prospectively collected data on all patients who underwent LF between 2010-2025, and were referred to our center for post-operative HRM regardless of symptoms. Post-LF evaluation included symptom scores (GerdQ, EHAS), barium swallow, HRM, 24-h pH-impedance, and endoscopy. Diagnostic accuracy was assessed against combined radiologic, endoscopic, and pH-monitoring criteria defining three postoperative phenotypes: hyperfunctional neo-barrier/post-fundoplication outflow obstruction (PFOO), ineffective neo-barrier (disrupted, intrathoracic, slipped), and functioning and effective LF (FELF) (Figure 1). Receiver operating characteristic (ROC) analysis evaluated the IRP performance for the diagnosis of PFOO. Results A total of 367 patients were included. Based on the Padova Classification, 74 patients (20.2%) had an ineffective neo-barrier, 67 (18.3%) had PFOO, 215 (58.6%) had FELF, and 7 (1.9%) showed absent contractility. PFOO patients exhibited higher preoperative LES basal pressure (p=0.01), LES total length (p=0.003), and LES abdominal length (p=0.019). Median postoperative IRP was 19.8 mmHg (19.0–22.0) in PFOO versus 9.6 mmHg (7.0–12.4) in FELF (p<0.001). Ineffective neo-barriers had higher postoperative AET than PFOO and FELF (p<0.001)(Figure 2). The Padova classification demonstrated high diagnostic accuracy across all phenotypes: PFOO (89.3% sensitivity, 98.1% specificity) (PPV 92.6%, NPV 97.1%); Ineffective neo-barriers (82% sensitivity, 97% specificity) (PPV 87.5%, NPV 94.8%); FELF (85% sensitivity, 95% specificity) and predictive values above 90%. (Figure 1). IRP showed excellent discrimination for post-Nissen PFOO (AUC 0.99; 95% CI 0.9878–1.000; p<0.0001), with an optimal cutoff of 18.10 mmHg (97.6% sensitivity, 97.8% specificity). Conclusion This study confirms that the Padova Classification demonstrates strong performance in assessing postoperative LF function and may serve as a valuable tool in clinical decision-making when integrated with other esophageal tests. It provides meaningful diagnostic discrimination, particularly in cases where radiologic or endoscopic assessments cannot clearly explain the persistence of postoperative symptoms.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.