Dolores T Mueller, Laura Knepper, Florian Gebauer, Wolfgang Schröder, Christiane J Bruns, Jessica M Leers, Hans F Fuchs. University of Cologne, Department of Surgery
Introduction: Laryngopharyngeal pH-monitoring (Restech) is a relatively new reflux testing device that needs more validation. It was developed to detect both liquid and acidic gas vapor, and the pharyngeal probe placement may lead to more reliable results in patients with laryngopharyngeal symptoms.
A negative Restech result could be used as a screening instrument for gastroesophageal reflux and help decide whether patients should be included into a diagnostic pathway or benefit from a PPI therapy. Aim of this study is to examine the value of negative Restech test results using a large patient collective.
Methods and procedures: In our esophageal center of excellence, more than 300 esophageal surgeries are performed annually. All patients undergoing minimally invasive or open upper gastrointestinal surgery are prospectively entered in our IRB approved database and undergo a routine check-up program with postoperative surveillance following surgery. All patients with benign disease received a complete diagnostic work-up for gastroesophageal reflux including symptom evaluation, endoscopy, 24-hour impedance pH-metry, high resolution manometry and Restech. Only patients with a complete dataset and oropharyngeal reflux symptoms were offered inclusion into this study and evaluated using 24-h laryngopharyngeal and simultaneous esophageal impedance pH-monitoring.
Results: A total of 155 [99 females] consecutive patients with suspected gastroesophageal reflux disease and oropharyngeal symptoms that were seen between 10/2013 and 08/2018 were included and underwent 24-h laryngopharyngeal with concomitant esophageal pH-monitoring.
Restech evaluation was negative for reflux (=normal) in 55.5% (n=86, mean RYAN Score upright 2.5 [2.12-8.57], mean RYAN Score supine 2.2 [2.17-5.86]). In 45.3% of Patients with a normal Restech evaluation, 24-hour pH-metry was pathologic (n=39, mean DeMeester Score 55.98 [14.8-254.9]). Nearly half of the patients with a normal RYAN and a normal DeMeester Score (n=20) did not complain about heart burn but only oropharyngeal symptoms. No patient with a normal RYAN Score and a normal DeMeester Score underwent antireflux surgery.
Conclusion: As shown in earlier research, Restech and 24-hour pH do not necessarily need to correspond. More women than men presented with oropharyngeal reflux related symptoms.
A negative Restech examination combined with a negative 24-hour pH metry may help to support the decision for or against antireflux surgery but is alone not suitable as a negative screening tool for GERD.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94104
Program Number: P467
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster