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Follow-up 96-hour Ph Testing In Patients After Esophageal Myotomy With Functional Luminal Imaging And Quality Of Life Outcome Metrics
*Zachary M Callahan, *Julia R Amundson, *Jordan Delev, *Kristine Kuchta, H. Mason Hedberg, Michael Ujiki
Northshore University HealthSystem, Evanston, IL

OBJECTIVE(S): The objective of this study is to determine the incidence of acid reflux in patients after esophageal myotomy, to assess the sensitivity of 96-hour pH testing, and to correlate these findings to perioperative functional luminal imaging probe measurements (FLIP) and quality of life outcome metrics.
METHODS: A prospectively maintained patient database at a single center was queried. Patients who underwent either Heller Myotomy or POEM (PerOral Endoscopic Myotomy) were reviewed and a subgroup of patients who underwent follow-up EGD with 96-hour pH monitoring were analyzed. The Wilcoxon rank-sum test was used to assess differences between groups.
RESULTS: Over a ten-year period, 223 patients underwent esophageal myotomy; Fifty patients (6 Heller Myotomy, 44 POEM) underwent follow-up endoscopy with pH monitoring at a median of 1.4 years post operatively. Forty patients (80%) had a DeMeester score >14.73 on any of the four days studied. Eight (20%) of these patients had a negative score on day one and went on to have a positive study in subsequent days. One patient had a negative score on day one and two then went on to have a positive study. Thirteen patients (24%) had LA Grade C or D esophagitis. Of the 40 patients with a positive DeMeester score, only 18 (45.5%) had significant symptom association probability. Patients with a positive DeMeester score had a higher post-myotomy distensibility index compared to those with a negative score (4.7 2.1 vs 2.8 1.1, P = 0.032). These patients also appeared to have higher GERD-HRQL scores at one and two years follow up though these failed to reach statistical significance (13.4 10.5 vs 6.5 7.2 P = 0.25, 12.5 9.9 vs 2.8 2.9 P = 0.06).
CONCLUSIONS: This study demonstrates a high incidence of acid reflux and severe esophagitis in patients after myotomy, with failure to identify a fifth of patients with reflux after a single day of monitoring. Less than half of patients with objective evidence of reflux had symptoms that significantly correlated to reflux episodes. Lastly, patients with reflux had a higher post-operative distensibility index compared to those without reflux.


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