Impact of Participation of Surgeons in Diagnostic Studies of Gastroesophageal Reflux Disease on Completion of Workup and Utilization of Antireflux Surgery

2020 ◽  
pp. 155335062095090
Author(s):  
Medhat Y. Fanous ◽  
Anja K. Jaehne ◽  
David Lorenson ◽  
Sarah Williams
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Antireflux Surgery ◽  
Surgical Intervention ◽  
Retrospective Chart Review ◽  
Diagnostic Workup ◽  
Rural Setting ◽  
Diagnostic Studies ◽  
General Surgeons

Introduction. Patients presenting with symptoms of gastroesophageal reflux disease (GERD) are usually evaluated by gastroenterologists who perform the diagnostic workup and determine when to refer for surgical consideration. The multiple diagnostic studies can be overwhelming, and this leads to dropouts. In a rural setting, without gastroenterology services, the surgeon can diagnose GERD and perform antireflux procedures. This study aimed to assess the completion of the required diagnostic studies and progression to surgical intervention. Methods. This is a retrospective chart review of patients who presented with GERD symptoms between August 2015 and January 2018. Standardized workup included the upper gastrointestinal study and esophagogastroduodenoscopy with concomitant wireless pH placement. High-resolution impedance manometry and the gastric emptying scan were selectively utilized. Results. 429 patients were evaluated. Proton pump inhibitors were used by 82.2% of patients. The required diagnostic workup was completed by 92.7% of all patients. Nearly 75% were suitable candidates for antireflux surgery. Approximately 2/3 of these patients proceeded with antireflux surgery. Discussion. The lack of gastroenterology services in rural hospitals provides a unique opportunity for general surgeons to diagnose and treat GERD patients locally. This avoids fragmentation of care and enables the surgeon to evaluate the entire spectrum of GERD. This structured approach results in increased completion of multiple diagnostic studies. Moreover, surgical candidates are likely to proceed with surgical intervention. Conclusion. A surgical antireflux program with diagnostic and therapeutic capabilities results in increased completion of diagnostic workup and utilization of antireflux surgery.

DOZ047.69: Tracking outcomes of tracheoesophageal fistula and esophageal atresia in pediatric population

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
I Sharma ◽  
S Thaker ◽  
T Jensen ◽  
C Finck
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Esophageal Atresia ◽  
Reflux Disease ◽  
Tracheoesophageal Fistula ◽  
Surgical Intervention ◽  
Clinical Pathways ◽  
Pediatric Population ◽  
Retrospective Chart Review ◽  
Congenital Deformity

Abstract Purpose The purpose of this study is to conduct a retrospective chart review of patients with a rare congenital deformity, tracheoesophageal fistula, and esophageal atresia treated at a small, freestanding Children's Hospital. The goal is to identify important variables to inform clinical pathways and prospective database creation. Current national surgical quality databases do not track tracheoesophageal fistula/esophageal atresia (TEF/EA)-specific data points such as TEF-type and incidence of postoperative complications such as gastroesophageal reflux disease (GERD) and esophageal stricture. Methods Patients diagnosed with esophageal atresia and trachesophageal fistula between January 2005 and January 2019 were identified using the appropriate ICD 9 or ICD 10 codes. Data for 35 variables including patient demographics and type of esophageal atresia were abstracted. SPSS 16.0 software was used for descriptive statistics. Results A total of 43 patients were identified, 64.3% female and 35.7% male. 77.5% were type C, 12.5% type A, 7.5% type H, and 2.5% type D. 15% were long-gap type. 53.8% had postoperative esophageal strictures, and 66.7% had postoperative gastroesophageal reflux disease. Of those who had strictures, 77.2% of patients required at least three postoperative dilations for stricture, with an overall mean six dilations. 26.2% of patients had tracheomalacia; of these, two patients underwent thoracoscopic aortopexy. Four patients were not included in subgroup analysis: two patients had missing variables, one patient passed away before surgical intervention, and one patient has not yet undergone surgical intervention for EA/TEF. Conclusions We conclude that, although a rare congenital anomaly, a database dedicated to tracheoesophageal fistula and esophageal atresia at a pediatric hospital can aid in reviewing trends in outcomes and inform standardization of management.

Drawbacks of the Current Algorithm for Patients With Symptoms of Gastroesophageal Reflux Disease and the Impact of Adding Wireless pH Study to the Initial Diagnostic Endoscopy: Data From High-Volume Rural Antireflux Center

2020 ◽  
Vol 86 (5) ◽  
pp. 422-428 ◽  
Author(s):  
Medhat Y. Fanous ◽  
Tyler Hughes
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Retrospective Chart Review ◽  
High Volume ◽  
Rural Setting ◽  
Time Interval ◽  
Ph Probe ◽  
Patient Dissatisfaction ◽  
The Impact

Background Patients with symptoms of gastroesophageal reflux disease (GERD) are often given a trial of proton pump inhibitors (PPIs). When they respond, patients usually continue PPI therapy. If this empiric treatment fails, esophagogastroduodenoscopy (EGD) is recommended. When EGD findings are equivocal, pH study is warranted. We hypothesize that this algorithm results in prolonged PPI therapy, repetition of EGDs and patient dissatisfaction. This study evaluates the impact of placing a pH probe at the time of the initial EGD. Methods IRB approval was obtained for retrospective chart review of patients who presented with GERD symptoms between August 2015 and March 2019. Patients were included if they underwent EGD with placement of wireless pH probe. Results A total of 379 patients (260 females, 119 males) with average age was 56.7±14.2 years. There were 253/379 (66.7%) patients who had previous EGDs (1-10). Health Satisfaction Survey was completed by 357/379 (94.2%) patients and 250/357 (70%) reported dissatisfaction with GERD control. PPI use was noted in 299/379 (78.8%) patients with average duration of 10.9±9.1 years. Testing off antisecretory medication was performed in 360/379 (94.9%). The average time interval between the clinic visit and performing EGD and pH study was 22±25 days. Conclusion The current GERD algorithm results in prolonged PPI therapy, repeated endoscopies and patient dissatisfaction. Placing a pH probe at the time of initial endoscopy is safe and expedient in a rural setting. Positive pH studies avoid repeating EGDs and negative pH studies warrant a search for potential alternative diagnosis.

Laparoscopic antireflux surgery with routine hiatoplasty in the treatment of gastroesophageal reflux disease

2001 ◽  
Vol 120 (5) ◽  
pp. A480-A480
Author(s):  
F GRANDERATH ◽  
U SCHWEIGER ◽  
T KAMOLZ ◽  
T BAMMER ◽  
M PASIUT ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Antireflux Surgery ◽  
Laparoscopic Antireflux Surgery

Gastroesophageal Reflux Disease: Integrating the Barium Esophagram before and after Antireflux Surgery

Radiology ◽  
2007 ◽  
Vol 243 (2) ◽  
pp. 329-339 ◽  
Author(s):  
Mark E. Baker ◽  
David M. Einstein ◽  
Brian R. Herts ◽  
Erick M. Remer ◽  
Gaspar Alberto Motta-Ramirez ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Antireflux Surgery ◽  
Before And After ◽  
Barium Esophagram

670a Gastroesophageal Reflux Disease (GERD) and Antireflux Surgery (ARS). What is the Proper Preoperative Work-up?

2012 ◽  
Vol 142 (5) ◽  
pp. S-1033 ◽  
Author(s):  
Brian L. Bello ◽  
Marco Zoccali ◽  
Roberto Gullo ◽  
Arunas E. Gasparaitis ◽  
Mustafa Hussain ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Antireflux Surgery ◽  
Preoperative Work Up ◽  
Work Up

scholarly journals Risk of Esophageal Adenocarcinoma After Antireflux Surgery in Patients With Gastroesophageal Reflux Disease in the Nordic Countries

JAMA Oncology ◽  
2018 ◽  
Vol 4 (11) ◽  
pp. 1576 ◽  
Author(s):  
John Maret-Ouda ◽  
Karl Wahlin ◽  
Miia Artama ◽  
Nele Brusselaers ◽  
Martti Färkkilä ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Esophageal Adenocarcinoma ◽  
Reflux Disease ◽  
Antireflux Surgery ◽  
Nordic Countries

scholarly journals Gastroesophageal Reflux Disease and Need for Antireflux Surgery in Children with Cystic Fibrosis: A Systematic Review on Incidence, Surgical Complications, and Postoperative Outcomes

2020 ◽  
Author(s):  
Jessica Ng ◽  
Florian Friedmacher ◽  
Caroline Pao ◽  
Paul Charlesworth
Keyword(s):  
Cystic Fibrosis ◽  
Postoperative Complications ◽  
Gastroesophageal Reflux Disease ◽  
Lung Function ◽  
Gastroesophageal Reflux ◽  
Nutritional Status ◽  
Reflux Disease ◽  
Antireflux Surgery ◽  
Published Data ◽  
Refractory Gerd

Abstract Introduction Gastroesophageal reflux disease (GERD) is associated with accelerated decline in lung health in children with cystic fibrosis (CF). Thus, antireflux surgery (ARS) is offered to a selected CF cohort with refractory GERD, but outcomes remain poorly investigated. This study aimed to determine the incidence of GERD in children with CF and to evaluate complications and outcomes of ARS. Materials and Methods A systematic literature-based search was conducted using various online databases according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The number of GERD cases in pediatric CF cohorts who underwent diagnostic investigation(s) was recorded. Data on postoperative complications and outcomes (including symptoms, lung function, and nutritional status) following ARS were analyzed. Results Ten articles (n = 289 patients) met the defined inclusion criteria (51% male; age range, 0.5 month–36 years). The overall incidence of GERD was 46% (range, 19–81%), derived from seven studies (n = 212 patients). Four publications (n = 82 patients) reported on ARS due to uncontrolled GERD. All ARSs were Nissen fundoplication (majority with gastrostomy placement). Major postoperative complications occurred in 15 (18%) patients, two required redo-ARS. Median follow-up time was 2 years (range, 3 months–6 years); 59% showed symptom improvement, and pulmonary exacerbations and decline in lung function were reduced. Nutritional status mainly improved in milder CF cases. There were no deaths related to ARS. Conclusion Approximately half of pediatric CF patients have GERD. Published data for children with CF are limited and heterogeneous in terms of GERD diagnosis and outcomes following ARS. However, ARS has shown to slow the deterioration of lung function in CF.

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