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You are here: Home / Abstracts / IS IT TIME FOR GENERAL SURGEONS TO PLACE WIRELESS pH PROBE AT THE TIME OF INITIAL ENDOSCOPY FOR PATIENTS WITH GASTROESOPHAGEAL REFLUX SYMPTOMS?

IS IT TIME FOR GENERAL SURGEONS TO PLACE WIRELESS pH PROBE AT THE TIME OF INITIAL ENDOSCOPY FOR PATIENTS WITH GASTROESOPHAGEAL REFLUX SYMPTOMS?

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.

Table One

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

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