Preoperative physiological esophageal assessment for anti-reflux surgery: A guide for surgeons on high-resolution manometry and pH testing

Table 2 Esophageal pH measurement options

	Overview	Benefits	Limitations
Twenty-four hours ambulatory catheter	Trans-nasal catheter placed 5 cm above the LES. Measures time of pH < 4	Can be placed in office	Catheter may cause discomfort; Patients may deviate from daily routine; Patients should refrain from taking PPI therapy during testing; False positives secondary eating/drinking acidic food
Wireless capsule	Small probe that is placed endoscopically in esophagus 5-6 cm above LES. Measures time of pH < 4	Little patient discomfort; Battery life of 48-96 h allows for better measurement of physiologic acid exposure	Must be placed endoscopically; Patients should refrain from taking PPI therapy during testing; False positives secondary eating/drinking acidic food
MII-pH catheter	Trans-nasal catheter placed 5 cm above LES. Contains pH probe along with electrodes to measure reflux episodes	Can be done on or off PPI; Measures pH and reflux independently; Patients can continue taking PPIs; Can identify patients with weak acid reflux	Catheter may cause discomfort; Patients must have prior manometry testing; False positive possible in patients with rumination, achalasia, and scleroderma

LES: Lower esophageal sphincter; PPI: Proton pump inhibitor.