Prospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2021; 13(6): 612-624
Published online Jun 15, 2021. doi: 10.4251/wjgo.v13.i6.612
Gastrointestinal function testing model using a new laryngopharyngeal pH probe (Restech) in patients after Ivor-Lewis esophagectomy
Benjamin Babic, Dolores T Müller, Florian Gebauer, Lars Mortimer Schiffmann, Rabi R Datta, Wolfgang Schröder, Christiane J Bruns, Jessica M Leers, Hans F Fuchs
Benjamin Babic, Dolores T Müller, Florian Gebauer, Lars Mortimer Schiffmann, Rabi R Datta, Wolfgang Schröder, Christiane J Bruns, Jessica M Leers, Hans F Fuchs, Department of General, Visceral, Cancer and Transplant Surgery, University of Cologne, Cologne 50931, Germany
Author contributions: Fuchs HF contributed to the study concept and design; Fuchs H and Müller DT acquired the data; Fuchs HF, Babic B, Leers JM, Schröder W and Bruns CJ contributed to analysis and interpretation of data; Fuchs HF and Babic B drafted the manuscript; Fuchs HF, Babic B, Müller DT, Gebauer F, Schiffmann LM, Datta RR, and Bruns CJ critically revised the manuscript for important intellectual content; Fuchs HF performed statistical analysis; Fuchs HF was charge of administrative, technical, or material support; Leers JM and Fuchs HF supervised the study.
Supported by Cologne Fortune Scientific Grant Project, No. 176/2016.
Institutional review board statement: The study was conducted with approval from the institutional review board at the University of Cologne (IRB reference 16-727).
Clinical trial registration statement: Our prospective clinical study has been registered in the “German Clinical Trial Register” and can be found under the following link: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011123. The study number is DRKS00011123.
Informed consent statement: All study participants provided written consent prior to study enrollment.
Conflict-of-interest statement: The authors of this manuscript having no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hans Friedrich Fuchs, MD, Assistant Professor, Surgeon, Department of General, Visceral, Cancer and Transplant Surgery, University of Cologne, Kerpener Straße 62, Cologne 50931, Germany. hans.fuchs@uk-koeln.de
Received: December 6, 2020
Peer-review started: December 6, 2020
First decision: January 29, 2021
Revised: February 11, 2021
Accepted: May 19, 2021
Article in press: May 19, 2021
Published online: June 15, 2021
Abstract
BACKGROUND

There is no established correlation between 24-h esophageal pH-metry (Eso-pH) and the new laryngopharyngeal pH-monitoring system (Restech) as only small case series exist. Eso-pH was not designed to detect laryngopharyngeal reflux (LPR) and Restech may detect LPR better. We have previously published a dataset using the two techniques in a large patient collective with gastroesophageal reflux disease. Anatomically, patients after esophagectomy were reported to represent an ideal human reflux model as no reflux barrier exists.

AIM

To use a human reflux model to examine our previously published correlation in these patients.

METHODS

Patients after Ivor Lewis esophagectomy underwent our routine follow-up program with surveillance endoscopies, computed tomography scans and further exams following surgery. Only patients with a complete check-up program and reflux symptoms were offered inclusion into this prospective study and evaluated using Restech and simultaneous Eso-pH. Subsequently, the relationship between the two techniques was evaluated

RESULTS

A total of 43 patients from May 2016 - November 2018 were included. All patients presented with mainly typical reflux symptoms such as heartburn (74%), regurgitation (84%), chest pain (58%), and dysphagia (47%). Extraesophageal symptoms such as cough, hoarseness, asthma symptoms, and globus sensation were also present. Esophageal 24-hour pH-metry was abnormal in 88% of patients with a mean DeMeester Score of 229.45 [range 26.4-319.5]. Restech evaluation was abnormal in 61% of cases in this highly selective patient cohort. All patients with abnormal supine LPR were also abnormal for supine esophageal reflux measured by conventional Eso-pH.

CONCLUSION

Patients following esophagectomy and reconstruction with gastric interposition can ideally serve as a human reflux model. Interestingly, laryngopharyngeal reflux phases occur mainly in the upright position. In this human volume-reflux model, results of simultaneous esophageal and laryngopharyngeal (Restech) pH-metry showed 100% correlation as being explicable by one of our reflux scenarios.

Keywords: Gastroesophageal reflux disease, Laryngopharyngeal reflux, Minimally invasive esophagectomy, Surgical technology, Restech, Esophageal pH-metry

Core Tip: There is no established correlation between 24-h esophageal pH-metry (Eso-pH) and the new laryngopharyngeal pH-monitoring system (Restech) as only small case series exist. Anatomically, patients after esophagectomy were reported to represent an ideal human reflux model as no reflux barrier exists. Patients after esophagectomy were evaluated using Restech and simultaneous Eso-pH. In this human volume-reflux model, Eso-pH correlated completely with laryngopharyngeal pH-metry (Restech).