Joslin N Cheverie, MD, Jenny Lam, Kai Neki, MD, Tokio Matsuzaki, MD, PhD, Santiago Horgan, MD. UC San Diego
Chronic anemia is often found to be a coincident diagnosis in patients with paraesophageal hernia (PEH). The presence of endoscopically identified ulceration (e.g. Cameron’s lesion) will frequently prompt surgical consultation in the otherwise asymptomatic patient with refractory anemia. Reported rates of anemia resolution following paraesophageal hernia repair (PEHR) often exceeds the prevalence of such lesions in the study population. The aim of this study was to characterize the resolution of anemia after (PEHR) with respect to endoscopic diagnosis.
Methods: Retrospective review of a prospectively maintained database of all patients with PEH and anemia who underwent PEHR from 2007 to 2018 was performed. Anemia determined by preoperative laboratory data that met 2011 WHO guidelines: Hgb <12 mg/dl in females, Hgb <13 mg/dl in males, or with ongoing iron supplementation. Improvement of postoperative anemia was assessed by both postoperative laboratory data of hemoglobin and unnecessity of iron supplementation intake.
Results: Among 56 identified patients, 45 were female (80.4%). 40 patients (71.4%) were anemic by hemoglobin value, 16 patients (28.6%) required iron supplementation. Mean age of 65.1 years and a mean BMI of 27.7kg/m2. Almost all cases were Type III PEH except for one case which was Type IV PEH. Preoperative esophagogastroduodenoscopy (EGD) was performed in 89.3% of patients. Among them, 64.0% of patients had potential source of anemia: 32.0% Cameron lesions, 12.0% gastric ulcers, 24.0% gastritis, and 2.0% had Barrett’s esophagitis. The remaining 36.0% had no abnormal findings on EGD. Median post-operative follow-up was160 days. Anemia resolution was seen in 46.4 % in total patients after PEHR. Notably, 72.2% (13 out of 18) of patients with no identified lesions on EGD had resolution in anemia. Of the 32 patients with pre-procedure Cameron lesions and gastric ulcers, 50% had resolution of anemia.
Conclusion: PEHR results in resolution of anemia in only 46.4% of patients. Patients with identifiable stomach ulcers showed similar outcome and patients without identifiable lesions on endoscopy also showed resolution. In patients with PEH and symptomatic anemia refractory to other therapy, PEHR might be considered.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95949
Program Number: S087
Presentation Session: Foregut III
Presentation Type: Podium