Matt Glasgow1, Christy M Dunst, MD2, Walaa Abdelmoaty, MD3, Rosen Ilchev, BA3, Naly Setthavongsack4, Hannah Creasey5, Daniel Davilla Bradley, MD2, Kevin M Reavis, MD2, Lee L Swanstrom, MD2, Steve R Demeester, MD2. 1Bates College, 2The Oregon Clinic, 3Providence Portland Medical Center, 4Portland State University, 5Lewis and Clark College
Introduction: Abnormal esophageal acid exposure, as measured by prolonged pH-testing, has long been considered the gold standard in the diagnosis of GERD. Importantly, an abnormally elevated acid score provides one of the most accurate predictors of a successful surgical outcome. Impedance technology has been applied to esophageal testing to quantitate the presence reflux regardless of chemical composition. Currently, combined multichannel-intraluminal impedance and standard pH-testing (MII-pH) has become common practice but little is known about the impact on surgical decision making. The aim of this study was to determine if an isolated abnormal esophageal impedance test is an adequate indication for antireflux surgery.
Methods: Patients who had an off-medication MII-pH test followed by antireflux surgery over 5 years were reviewed. Patients with abnormal impedance were selected. Only patients with standard antireflux surgery were included (fundoplication/type 1 hiatal hernia repair). An abnormal pH-test was defined as DeMeester score > 14.7. An abnormal impedance test was defined as > 47 reflux events. Patients were divided into two groups: abnormal pH/abnormal impedance [pH+MII+] and normal pH/abnormal impedance [pH–MII+]. Patients were contacted by telephone for a postoperative interview. Patients were asked to rate their symptom resolution on a scale of 1 (no resolution) to 5 (complete resolution).
Results: Eighty-two patients met criteria: 44 [pH+MII+] and 38 [pH–MII+] There were no differences in the baseline demographics or indications for surgery between the groups. Both groups experienced significant reduction in symptoms with overall symptom resolution score 4.19. The mean symptom resolution score was lower for the [pH–MII+] group than the [pH+MII+] (3.95 vs. 4.41, p < 0.05). Preoperative regurgitation or hiatal hernia specifically did not increase the likelihood of a successful outcome.
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Discussion: Isolated abnormal esophageal impedance off medication is an adequate indication for antireflux surgery. Patients who have abnormal esophageal acid scores on preoperative pH-testing have slightly improved outcomes compared to those who have abnormal impedance alone, specifically regarding heartburn and dysphagia. Preoperative factors such as regurgitation or hiatal hernias were not associated with further improvement in outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95430
Program Number: S047
Presentation Session: Foregut II – Physiology
Presentation Type: Podium