Hans F Fuchs, MD, Dolores Mueller, Felix Berlth, MD, Claudia Fuchs, MD, Patrick Plum, MD, Martin Maus, MD, Wolfgang Schroeder, MD, Christiane Bruns, MD, Jessica Leers, MD. University of Cologne, Department of General Surgery
Introduction: Laryngopharyngeal PH monitoring is a relatively new reflux testing device that needs more validation. Previous studies have shown that patients after esophagectomy can ideally serve as a human reflux model. Aim of this study is to further evaluate the acid exposition based on a newly developed minimally invasive laryngopharyngeal PH monitoring device (Restech) and to correlate the results with conventional esophageal pH monitoring.
Methods: In our esophageal center of excellence, more than 250 esophageal surgeries are performed annually. All patients undergoing minimally invasive hybrid Ivor Lewis esophagectomy are prospectively entered in our IRB approved database and undergo a routine check-up program with yearly surveillance endoscopies and further exams following surgery. Only patients with a complete check-up program and reflux symptoms were offered inclusion into this study and evaluated using 24-h laryngopharyngeal and concomitant esophageal pH-monitoring. Subsequently, the relationship between the two techniques was evaluated. A total of 75 patients with R0 resection and reflux symptoms after esophagectomy are scheduled to be included in this prospective study.
Results: A total of 35 (7 females) patients with a median age of 62 (range 39-80) were recruited from 05/2016-09/2017 after minimally invasive Ivor Lewis esophagectomy (median follow up 29 months). Adenocarcinoma was present in 23 patients, squamous cell carcinoma in 12 patients. All patients showed mucosal damage of the esophageal remnant upon endoscopic evaluation. GERD related symptoms were found in all patients: heart burn (70%), dysphagia (42%), regurgitation (72%), cough (19%), hoarseness (7%), globus sensation (30%), and retrosternal pain (60%). A total of 30 patients (86%) had a pathological conventional esophageal pH metry. In laryngopharyngeal pH metry, 24 patients (69%) had pathological acid exposure. In these patients, laryngopharyngeal reflux was more present in the upright (100%, mean Ryan Score 109 [range, 10-409]) than in the supine position (23%, mean Ryan Score 15 [range, 2.2-149]). In this human reflux model, esophageal pH metry correlated well with laryngopharyngeal pH metry (94%).
Fig.1 Restech Device, intraoral placement
Conclusion: Patients following esophagectomy and reconstruction with gastric interposition do ideally serve as a human reflux model. Interestingly, laryngopharyngeal reflux phases occur mainly in the upright position. This study helps to further validate laryngopharyngeal pH-metry.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87050
Program Number: P493
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster