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The outcome of fundoplication in patients with GERD based on abnormal impedance testing

  • 2019 SAGES Oral
  • Published:
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Abstract

Introduction

The role of impedance testing in selecting patients for antireflux surgery is poorly understood. The aim of this study was to compare the outcomes of patients that underwent antireflux surgery for GERD based on an abnormal pH/abnormal impedance test versus a normal pH/abnormal impedance test.

Methods

Records of patients who had an abnormal off-medication impedance test (≥ 48 total reflux events) who underwent antireflux surgery were reviewed and divided into two groups: normal [pH−] or abnormal [pH+] esophageal acid exposure (DeMeester score > 14.7). Symptom resolution was compared: scale 1 (no resolution) to 5 (complete resolution).

Results

Eighty-two patients met criteria: 44 [pH+] and 38 [pH−]. There were no differences in the demographics or indications for surgery. The frequencies of heartburn and regurgitation symptoms were significantly reduced by fundoplication in both groups. Complete resolution of heartburn was more common in the [pH+] group (90%) compared to the [pH−] group (67%) [p = 0.02]. Resolution of regurgitation was similar in both groups (90% in the [pH+] group vs 79% in the [pH−] group, p = 0.20). The mean dysphagia frequency score decreased for the [pH+] group, but increased in the [pH−] group. New-onset dysphagia was more common in [pH−] patients (23%) compared to [pH+] patients (5%), (p = 0.02). Continued use of PPI medications was significantly more likely in [pH−] group (42%) compared to the [pH+] group (21%). There was no difference in surgical satisfaction rates between groups.

Discussion

Patients with abnormal impedance and increased esophageal acid exposure had significantly better symptom resolution, less dysphagia, and less frequent PPI use with antireflux surgery versus those with normal pH. These findings urge caution in the use of abnormal impedance values with normal esophageal acid exposure for the selection of patients for an antireflux operation.

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Authors and Affiliations

  1. Bates College, Lewiston, ME, USA

    M. E. Glasgow

  2. The Foundation for Surgical Innovation and Education, Portland, OR, USA

    C. M. Dunst, W. F. Abdelmoaty, N. Setthavongsack, H. Creasey, D. Davila Bradley, K. M. Reavis, L. L. Swanstrom & S. R. Demeester

  3. Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, 4805 NE Glisan Street Suite, 6N60, Portland, OR, 97213, USA

    C. M. Dunst, W. F. Abdelmoaty, D. Davila Bradley, K. M. Reavis, L. L. Swanstrom & S. R. Demeester

Authors
  1. M. E. Glasgow
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  2. C. M. Dunst
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  3. W. F. Abdelmoaty
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  4. N. Setthavongsack
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  5. H. Creasey
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  6. D. Davila Bradley
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  7. K. M. Reavis
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  8. L. L. Swanstrom
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  9. S. R. Demeester
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Corresponding author

Correspondence to C. M. Dunst.

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Disclosures

Dr. Reavis is a consultant for Boston Scientific, Endogastric Solutions, and Stryker, and receives teaching or advisory honoraria from Ethicon, Mederi, Gore, and Apollo. Dr. Swanstrom is on the scientific advisory boards of Olympus, Apollo, Titan, and Boston Scientific. Dr. DeMeester is a consultant for Bard, Gore, Endogastric Solutions, C2 Therapeutics, Novadaq, Mauna Kea, and CDx Diagnostics. Dr. Dunst is a consultant for Bard Davol. These disclosures are not relevant to the current study.Authors Matt Glasgow, Naly Setthavongsack, Hannah Creasey, Dr. Davila Bradley, and Dr. Abdelmoaty have no disclosures.

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Glasgow, M.E., Dunst, C.M., Abdelmoaty, W.F. et al. The outcome of fundoplication in patients with GERD based on abnormal impedance testing. Surg Endosc 34, 2601–2607 (2020). https://doi.org/10.1007/s00464-019-07029-w

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  • DOI: https://doi.org/10.1007/s00464-019-07029-w

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