Prospective Assessment of Patient Selection for Antireflux Surgery by Combined Multichannel Intraluminal Impedance pH Monitoring
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Selecting gastroesophageal reflux disease (GERD) patients for surgery on the basis of standard 24-h pH monitoring may be challenging, particularly if this investigation does not correlate with clinical symptoms. Combined multichannel intraluminal impedance pH monitoring (MII-pH) is able to physically detect each episode of intraesophageal bolus movements, enabling identification of either acid or non-acid reflux episodes and thus establish the association of the reflux with symptoms.
Materials and Methods
We prospectively assessed and reviewed data from 314 consecutive patients who underwent MII-pH for GERD not responsive or not compliant to proton pump inhibitor therapy. One hundred fifty-three patients with a minimum follow-up of 1 year constituted the study population. Clinical outcomes and satisfaction rate were collected in all patients who underwent laparoscopic Nissen–Rossetti fundoplication. Outcomes were reported for patients with normal and ineffective peristalsis and for patients with positive pH monitoring, negative pH monitoring and positive total number of reflux episodes at MII, and negative pH monitoring and normal number of reflux episodes at MII and a positive symptom index correlation with MII.
The overall patient satisfaction rate was 98.3%. No differences were recorded in the clinical outcomes of the patients with preoperative normal and ineffective peristalsis. No differences in patients’ satisfaction and clinical postoperative DeMeester symptom scoring system were noted between the groups as determined by MII-pH.
MII-pH provides useful information for objective selection of patients to antireflux surgery. Nissen fundoplication provides excellent outcomes in patients with positive and negative pH and positive MII monitoring or Symptom Index association. More extensive studies are needed to definitively standardize the useful MII-pH parameters to select the patient to antireflux surgery.
KeywordsMultichannel intraluminal impedance GERD Antireflux surgery Nissen MII-pH
gastroesophageal reflux disease
combined multichannel intraluminal pH monitoring
lower esophageal sphincter
laparoscopic Nissen–Rossetti fundoplication
- 7.Del Genio G, Rossetti G, Brusciano L, Limongelli P, Pizza F, Tolone S, et al. Laparoscopic Nissen-Rossetti fundoplication with routine use of intraoperative endoscopy and manometry: technical aspects of a standardized technique. World J Surg 2007;31:1099–106. doi:10.1007/s00268-006-0495-5.PubMedCrossRefGoogle Scholar
- 8.del Genio G, Tolone S, Rossetti G, Brusciano L, del Genio F, Pizza F, et al. Total fundoplication does not obstruct the esophageal secondary peristalsis: investigation with pre- and postoperative 24-hour pH-multichannel intraluminal impedance. Eur Surg Res 2008;40:230–234. doi:10.1159/000111146.PubMedCrossRefGoogle Scholar
- 9.Rossetti G, Brusciano L, Amato G, Maffettone V, Napolitano V, Russo G, et al. A total fundoplication is not an obstacle to esophageal emptying after heller myotomy for achalasia: results of a long-term follow up. Ann Surg 2005;241:614–21. doi:10.1097/01.sla.0000157271.69192.96.PubMedCrossRefGoogle Scholar
- 10.Del Genio G, Tolone S, Rossetti G, Brusciano L, Pizza F, del Genio F, et al. Objective assessment of gastroesophageal reflux after extended Heller myotomy and total fundoplication for achalasia with the use of 24 hour combined multichannel intraluminal impedance and pH monitoring (MII-pH). Dis Esophagus 2008, Jun 17 [Epub ahead of print].Google Scholar
- 14.Del Genio G, Tolone S, del Genio F, Rossetti G, Brusciano L, Pizza F, Fei L, del Genio A. The total fundoplication controls acid and non-acid reflux. Evaluation by pre- and postoperative 24 hour pH-multichannel intraluminal impedance. Surg Endosc 2008, May 14. doi:10.1007/s00464-008-9958-0.