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Selective use of esophageal manometry and 24-Hour pH monitoring before laparoscopic fundoplication.
J Am Coll Surg 2003; 197(3):358-63; discussion 363-4JA

Abstract

BACKGROUND

Preoperative esophageal manometry and 24-hour pH monitoring commonly are used in preoperative evaluation of patients undergoing fundoplication. Here we review our experience with the selective preoperative workup of patients undergoing fundoplication to treat gastroesophageal reflux disease.

STUDY DESIGN

A series of 628 consecutive antireflux procedures was reviewed. History and physical examination, upper endoscopy, and upper gastrointestinal videofluoroscopy were obtained preoperatively on all patients; the first 30 patients also underwent esophageal manometry and pH monitoring (routine evaluation group). Thereafter, pH monitoring only was performed for atypical reflux symptoms, and manometry only was performed for a history of dysphagia, odynophagia, or for abnormal motility on videofluoroscopy (selective evaluation group). All patients underwent a laparoscopic floppy Nissen fundoplication, and then endoscopy and fluoroscopy at 3 months and 12 months postoperatively.

RESULTS

Eighty-five of the patients in the selective evaluation group (14%) required manometry, and 88 (15%) underwent pH monitoring. Eighteen of the 115 patients who underwent manometry (16%) had evidence of dysmotility. None of these 18 patients had increased dysphagia postoperatively; 8 of 18 reported improvement with swallowing. Five patients in the selective group (0.8%) had persistent postoperative dysphagia caused by technical error (four patients) or with no identifiable cause (one patient). The estimated charge or collection reduction with use of the selective evaluation was 1,253,100 US dollars or 395,000 US dollars, respectively.

CONCLUSIONS

Selective use of manometry and pH monitoring was cost effective and safe in this series. Although esophageal manometry and 24-hour pH monitoring might be necessary with abnormal findings on videofluoroscopy or atypical symptoms, in our experience, their routine use is not essential in preoperative evaluation of patients undergoing fundoplication for gastroesophageal reflux disease.

Authors+Show Affiliations

Department of Surgery, Rush University, Chicago, IL 60612, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12946787

Citation

Frantzides, Constantine T., et al. "Selective Use of Esophageal Manometry and 24-Hour pH Monitoring Before Laparoscopic Fundoplication." Journal of the American College of Surgeons, vol. 197, no. 3, 2003, pp. 358-63; discussion 363-4.
Frantzides CT, Carlson MA, Madan AK, et al. Selective use of esophageal manometry and 24-Hour pH monitoring before laparoscopic fundoplication. J Am Coll Surg. 2003;197(3):358-63; discussion 363-4.
Frantzides, C. T., Carlson, M. A., Madan, A. K., Stewart, E. T., & Smith, C. (2003). Selective use of esophageal manometry and 24-Hour pH monitoring before laparoscopic fundoplication. Journal of the American College of Surgeons, 197(3), pp. 358-63; discussion 363-4.
Frantzides CT, et al. Selective Use of Esophageal Manometry and 24-Hour pH Monitoring Before Laparoscopic Fundoplication. J Am Coll Surg. 2003;197(3):358-63; discussion 363-4. PubMed PMID: 12946787.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Selective use of esophageal manometry and 24-Hour pH monitoring before laparoscopic fundoplication. AU - Frantzides,Constantine T, AU - Carlson,Mark A, AU - Madan,Atul K, AU - Stewart,Edward T, AU - Smith,Claire, PY - 2003/8/30/pubmed PY - 2003/10/1/medline PY - 2003/8/30/entrez SP - 358-63; discussion 363-4 JF - Journal of the American College of Surgeons JO - J. Am. Coll. Surg. VL - 197 IS - 3 N2 - BACKGROUND: Preoperative esophageal manometry and 24-hour pH monitoring commonly are used in preoperative evaluation of patients undergoing fundoplication. Here we review our experience with the selective preoperative workup of patients undergoing fundoplication to treat gastroesophageal reflux disease. STUDY DESIGN: A series of 628 consecutive antireflux procedures was reviewed. History and physical examination, upper endoscopy, and upper gastrointestinal videofluoroscopy were obtained preoperatively on all patients; the first 30 patients also underwent esophageal manometry and pH monitoring (routine evaluation group). Thereafter, pH monitoring only was performed for atypical reflux symptoms, and manometry only was performed for a history of dysphagia, odynophagia, or for abnormal motility on videofluoroscopy (selective evaluation group). All patients underwent a laparoscopic floppy Nissen fundoplication, and then endoscopy and fluoroscopy at 3 months and 12 months postoperatively. RESULTS: Eighty-five of the patients in the selective evaluation group (14%) required manometry, and 88 (15%) underwent pH monitoring. Eighteen of the 115 patients who underwent manometry (16%) had evidence of dysmotility. None of these 18 patients had increased dysphagia postoperatively; 8 of 18 reported improvement with swallowing. Five patients in the selective group (0.8%) had persistent postoperative dysphagia caused by technical error (four patients) or with no identifiable cause (one patient). The estimated charge or collection reduction with use of the selective evaluation was 1,253,100 US dollars or 395,000 US dollars, respectively. CONCLUSIONS: Selective use of manometry and pH monitoring was cost effective and safe in this series. Although esophageal manometry and 24-hour pH monitoring might be necessary with abnormal findings on videofluoroscopy or atypical symptoms, in our experience, their routine use is not essential in preoperative evaluation of patients undergoing fundoplication for gastroesophageal reflux disease. SN - 1072-7515 UR - https://www.unboundmedicine.com/medline/citation/12946787/Selective_use_of_esophageal_manometry_and_24_Hour_pH_monitoring_before_laparoscopic_fundoplication_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1072-7515(03)00591-X DB - PRIME DP - Unbound Medicine ER -