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EVALUATING LYON CONSENSUS 2.0 VS. DEMEESTER SCORE: PREDICTIVE ACCURACY OF ESOPHAGEAL ACID EXPOSURE CRITERIA FOR ANTIREFLUX SURGERY OUTCOMES
Sven Eriksson
*1,3, Inanc Sarici
1,3, Amanda Scobie
1, Nicholas Belleza
1, Mara Fryer
1, Ping Zheng
1, Shahin Ayazi
1,2,31Foregut Division, Surgical Institute, Allegheny Health Network, Pittsburgh, PA; 2Department of Surgery, Drexel University, Philadelphia, PA; 3Chevalier Jackson Research Fellowship, Esophageal Institute, Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh, PA
Introduction: Abnormal distal esophageal acid exposure is a well-established predictor of antireflux surgery (ARS) outcome. Abnormal DeMeester score on ?1 day of 48-hour ambulatory pH-monitoring or Los Angeles grade C/D esophagitis are commonly used in patient selection. The Lyon consensus 2.0 updated the criteria for GERD with grade B, C or D esophagitis as diagnostic. A >6% acid exposure time (AET) on ?2 days of pH-monitoring was also diagnostic. However, whether these updated factors better predict ARS outcomes remains untested. The aim of this study was to compare the predictive value of diagnostic criteria proposed in the Lyon consensus 2.0 to abnormal DeMeester score for ARS outcomes.
Methods: We evaluated patients who underwent primary antireflux surgery at our center with preoperative endoscopy and 48-hour wireless pH-monitoring. Favorable outcome was defined as patient satisfaction and freedom from proton pump inhibitors. A DeMeester score >14.7 was considered abnormal. We compared probabilities of favorable outcomes based on abnormal DeMeester score (?1 day) to grade C/D esophagitis, grade B/C/D esophagitis, and >6% AET on ?2 days. Additionally, favorable outcomes were compared between grade B vs C/D esophagitis and 4-6% vs >6% AET.
Results: There were 678 patients [median (IQR) age 59.0 (49-67); 67.4% female; BMI 29.1 (26-57)] who underwent antireflux surgery. Esophagitis was grade B in 19.9% and grade C or D in 13.7%. DeMeester score was 40.3 (27-57) with 90.7% abnormal on ?1 day. At 12.0 (6-14) months after surgery 84.1% achieved favorable outcome.
Favorable outcome was achieved by 82.6% of patients with an abnormal DeMeester score on ?1 day, 86.4% of patients with grade B/C/D esophagitis, 87.1% of patients with grade C/D esophagitis, and 85.2% of patients with >6% AET on ?2 days. Patients with grade B/C/D esophagitis or >6% AET on ?2 days achieved 84.6%, and patients with grade C/D or >6% AET on ? days achieved 85.5% favorable outcome (
Table).
The predictive accuracy of abnormal DeMeester score on ?1 day was compared to all other definitions as shown in the
Figure. All definitions were comparable.
Favorable outcome was not different between grade B and grade C/D esophagitis (p=0.800). Patients with 4-6% AET were significantly less likely to favorable outcome compared to those with >6% AET (67.1% vs. 84.3%; p=0.0009).
Conclusions: The predictive accuracy of all esophageal acid exposure definitions were comparable. Thus, the Lyon consensus 2.0 interpretation of pH-monitoring findings adds complexity without enhancing clinical utility in predicting ARS outcomes. Grade B esophagitis had a similar favorable outcome rate to grades C/D. This finding supports including grade B esophagitis the GERD definition.
Table
Figure. ROC curves comparing the predictive accuracy for favorable outcome of antireflux surgery of abnormal DeMeester score on ? 1 day to grade B/C/D esophagitis, grade C/D esophagitis, >6% AET on ?2 days, grade B/C/D esophagitis or >6% time pH<4 on ?2 days, and grade C/D esophagitis or >6% time pH<4 on ?2 days. All parameters were comparable.
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