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REFLUXASSOCIATED INJURY OF THE REMANT ESOPHAGUS AFTER ESOPHAGECTOMY AND GASTROINTESTINAL FUNCTION TESTING USING THE NEW LARYNGOPHARYNGEAL PH PROBE IN A HUMAN REFLUX MODEL
Jessica Leers*, Hans F. Fuchs, Sebastian Brinkmann, Felix Berlth, Martin Maus, Wolfgang Schröder, Christiane Bruns
University Hospital of Cologne, Koeln, NRW, Germany
Introduction: Gastro-esophageal reflux is a common problem following esophagectomy and reconstruction with gastric interposition. Due to the loss of the lower esophageal sphincter and other anatomical alterations these patients can ideally serve as a human reflux model. Aim of this study is to further evaluate the role of laryngopharyngeal PH monitoring (Restech) in this reflux model and to correlate the results with conventional esophageal pH monitoring.
Methods: An research grant application for this prospective clinical trial was submitted and approved by our academic center (project no. 176/2016). All patients undergoing esophagectomy are prospectively entered in our IRB approved database. All patients undergo a routine check-up program with yearly surveillance endoscopies and further exams following esophagectomy. Only patients with a complete check-up program and reflux symptoms were included into this study and were evaluated using 24-h laryngopharyngeal and concomitant esophageal pH-monitoring. Subsequently, the relationship between the two techniques was evaluated. Results: We enrolled the first 15 patients in this prospective study. 69% of the patients had a pathological laryngopharyngeal pH Metry. In these patients laryngopharyngeal reflux was more present in the upright (100%, mean Ryan Score 65.5 [range, 10-316]) than in the supine position (22%, mean Ryan Score 4.22 [range, 2.17-11.49]). All patients with positive supine laryngopharyngeal reflux were also positive for supine esophageal reflux. Esophageal pH metry correlated well with laryngopharyngeal pH metry in this human reflux model. Having a volume of >200 esophagectomies in 2015, we expect a recruitment of 5 patients per month that will prospectively be included in this study and presented.
Conclusion: Patients following esophagectomy and reconstruction with gastric interposition do ideally serve as a human reflux model. Interestingly, reflux phases occur mainly in the upright position. Further validation of the laryngopharyngeal pH-Metry seems possible with further recruitment of patients in this study.
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