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

Abstract

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.

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

“…Combining multiple GERD diagnostic modalities has been shown to increase patient compliance with workup and resultant increase in antireflux procedures. 15 The average duration of time to motility studies in the endoFLIP group was 3.6 days less than the HRIM group (16.8 vs 20.4 days). The difference in mode is more revealing and highlights the time saved in the endoFLIP group (8 vs 23 days).…”

Building a Comprehensive Rural Anti-Reflux Center

“…Approximately 2/3 (65.2%) of these patients proceeded with anti-reflux surgery. 3 In contrast, surgeons who depend on GERD patient referrals from gastroenterologists evaluate less than 1% of eligible patients for anti-reflux procedures. 11 Eighth, we challenged the medical and surgical dogma of the management of GERD by demonstrating the drawbacks of the current GERD algorithm and modifying it.…”

“…In a series of 379 patients, approximately 80% of these patients had EGD with concomitant pH study within 4 weeks of the initial consultation. 3 Third, we offer a comprehensive GERD evaluation utilizing EGD, wireless pH study and endoFLIP, high resolution esophageal manometry with impedance, esophagram, and gastric emptying study. 6 Fourth, the rural surgeon has the opportunity to train and build an efficient, consistent team.…”

“…This protocol resulted in repeated endoscopy, multiple trips, loss of productivity, conflicting treatment strategies, and increased patient dropout. 3,4 We envisaged establishing a comprehensive anti-reflux program with diagnostic and therapeutic capabilities locally.…”

“…This protocol resulted in repeated endoscopy, multiple trips, loss of productivity, conflicting treatment strategies, and increased patient dropout. 3,4…”