Impact of Endoscopic Training for Surgeons on Endolumenal and Laparoscopic Treatment for Gastroesophageal Reflux Disease: Data from a Rural, High-Volume Antireflux Program

Fanous, Medhat; Jaehne, Anja Kathrin; Lorenson, David; Williams, Sarah

doi:10.1177/000313481808400714

Cited by 6 publications

(9 citation statements)

References 5 publications

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“…This study underscores the benefits of establishing surgical antireflux centers with diagnostic and therapeutic antireflux capabilities. 16 These centers prevent fragmentation of care for GERD patients. The surgeon evaluates the entire spectrum of GERD and tailors the antireflux options according to the severity and characteristics of the disease.…”

Section: Discussionmentioning

confidence: 99%

The Outcomes of Performing Partial Fundoplication Based on Endoflip Versus Manometric Findings

Fanous

Wei

2021

The American Surgeon™

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Background The surgical management of gastroesophageal reflux disease (GERD) involves extensive diagnostic studies and sophisticated surgical techniques. The workup should be comprehensive and purposeful. High resolution impedance manometry (HRIM) provides valuable information regarding peristalsis and lower esophageal sphincter relaxation. The disadvantages of HRIM such as intolerance or inability to pass the catheter led to its selective use or even omission especially in laparoscopic hiatal hernia repair with partial fundoplication. This pragmatic approach risks missing motility disorders in patients with secondary reflux symptoms related to achalasia or scleroderma. Endolumenal functional lumen imaging probe (endoFLIP) can fill this void as it evaluates the dynamics of the esophagogastric junction under sedation. This study aims to compare the outcomes of preoperative use of HRIM vs endoFLIP for laparoscopic repair of hiatal hernia with partial fundoplication. Methods This is a retrospective cohort study for consecutive patients who underwent antireflux surgery with partial fundoplication between July 2018 and February 2021. Preoperative and postoperative outcomes were compared between two cohorts of patients: those with preoperative HRIM and those with preoperative endoFLIP. Results A total of 72 patients were evaluated, 41 had preoperative HRIM and 31 had endoFLIP. There was no statistically significant difference in their age, sex, BMI, duration of GERD symptoms, or proton pump inhibitors use. The endoscopic findings of esophagitis, hiatal hernia, and Hill’s grade were comparable. There was no difference in the American Society of Anesthesiology classification or the choice of antireflux surgery. The improvement of postoperative GERD scores and dysphagia subscore was similar between the two groups. Conclusion Performing partial fundoplication based on endoFLIP evaluation of the dynamics of the esophagogastric junction is safe and does not increase postoperative dysphagia compared to preoperative manometric use. Randomized prospective studies are needed to confirm the findings of this study.

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Section: Discussionmentioning

confidence: 99%

The Outcomes of Performing Partial Fundoplication Based on Endoflip Versus Manometric Findings

Fanous

Wei

2021

The American Surgeon™

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“…First, there is limited gastroenterology services in rural United States with a growing number of surgeons performing their own diagnostic workup who should have an input in the management of their GERD patients. 15 Second, the financial burden for rural patients is greater than that of urban patients due to the longer travel times, accommodation cost, and need for a companion due to endoscopy under sedation. This additional cost can theoretically offset the extra expenses of adding a pH study.…”

Section: Discussionmentioning

confidence: 99%

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

Fanous

Hughes

2020

The American Surgeon™

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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.

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“…The endoscopic and laparoscopic training of rural surgeons was shown to have clinical, and financial, on the local community. 2 There are multiple challenges in comprehensive assessments of GERD patients and deciding their surgical candidacy. First, multiple tests are required, and they are often performed separately, which leads to loss of days of work.…”

Section: Discussionmentioning

confidence: 99%

“…In a rural setting, without gastroenterology services, the surgeon can diagnose GERD and perform antireflux procedures. 2 This combined diagnostic and therapeutic approach avoids fragmentation of care. The aim of this study was to assess the impact of this approach in diagnostic workup on the completion of the required diagnostic studies and progression to surgical intervention.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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Impact of Endoscopic Training for Surgeons on Endolumenal and Laparoscopic Treatment for Gastroesophageal Reflux Disease: Data from a Rural, High-Volume Antireflux Program

Cited by 6 publications

References 5 publications

The Outcomes of Performing Partial Fundoplication Based on Endoflip Versus Manometric Findings

The Outcomes of Performing Partial Fundoplication Based on Endoflip Versus Manometric Findings

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

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

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