Medhat Fanous, MD, FACS, Anja Jaehne, MD, Amanda Lambert, RN, David Lorenson, RN. Aspirus Iron River Hospital
Introduction: Patients with symptoms of Gastroesophageal reflux disease (GERD) are often given a trial of proton pump inhibitors (PPIs). Despite low diagnostic yield, esophagogastroduodoscopy (EGD) is usually offered when empiric treatment fails. When a pH study is warranted to confirm diagnosis, it requires repeated endoscopy with potential procedural risks and additional cost. Gastroenterologists rather than general surgeons typically place pH probes.
Methods: A retrospective chart review was undertaken of patients presenting with GERD symptoms, to a general surgical clinic, between August 2015 and December 2017, who underwent EGD with concomitant placement of wireless pH probe. The probe was placed 6 cm proximal to the gastroesophageal junction. A DeMeester score ≥ 14.7 was considered positive.
Results: 298 patients were evaluated (table 1). PPI usage was 11± 9.1 years. 197/298 (66.2%) had previous EGDs. 281/298 (94.2%) patients were tested off PPIs. 223/298 (74.8%) had positive pH tests. Aspiration of pH probe occurred when one patient (0.3%) violently coughed during placement. This patient was intubated and capsule was retrieved via bronchoscopy. Inconclusive studies were noted in 6/298 (2%) patients. Four of them were due to misplacement (proximal or distal to intended location) and two had faulty probes.
Conclusion: Concomitant EGD and placement of pH probe by endoscopically trained surgeon is safe and confirms the diagnosis of GERD. Positive pH studies avoid repeating EGDs for the purpose of diagnosing GERD. Negative pH studies warrant a search for potential alternative diagnosis and can result in a decrease of inappropriate PPI utilization.
|
Demographic Female: Male Age BMI |
203:95 16-79 (57± 14.7) 30.3± 6.3 |
|
Duration (years) GERD symptoms PPIs |
14.7±11.3 11± 9.1 |
|
Previous EGDs None Yes Number of EGDs |
101/298 (33.8%) 197/298 (66.2%) 1-9 (1.9) |
|
pH study Off PPI On PPI Positive pH study Positive pH study on PPI Negative pH study Inconclusive |
281/298 (94.2%) 17/298 (5.8%) 223/298 (74.8%) 9/17 (52.9%) 69/298 (23.1%) 6/298 (2%) |
|
DeMeester score Composite Day 1 Day 2 |
28±26 25±27 30±29 |
|
Complications Aspiration of Bravo capsule Misplacement of Bravo capsule |
1/298 (0.03%) 4/298 (0.01%) |
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 92039
Program Number: P420
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster