Author(s)
T. Giordano
M. Ryan
Affiliation(s)
Children's Hospital Of Philadelphia; Children's Hospital Of Philadelphia
Abstract:
INTRODUCTION: Although there is controversy surrounding the use of impedance testing affecting outcomes of children undergoing LTR, we believe that routine GERD screening allows treatments that significantly improve outcomes in children undergoing LTR. OBJECTIVES: Study’s primary objective was to determine if the EGD and impedance testing results impact treatment decisions in patients undergoing preoperative LTR evaluation. We aim to review subjects’ results to determine the incidence of adding a new medication, medication dose adjustment, dietary changes and surgical interventions. METHODS: Observational case series with retrospective chart review analyzing existing patient preoperative evaluation LTR data from January 2008 through June 2014. Primary endpoint was to determine EGD utility and esophageal impedance monitoring, and if changes in medical management, such as addition/adjustment of medication doses, avoidance of potential food allergens or surgical interventions were recommended based on EGD and pH impedance study results. RESULTS: Seventy-six patients were included. Sixty-one patients had subglottic stenosis and 65 a tracheostomy in place. Sixty-three reported GERD symptoms, 13 reported none, 23 had a previous fundoplication with 11 having abnormal results. On gross appearance of EGD, 66 had normal results, 4 patients had esophagitis and 7 had gastritis. Sixty had normal EGD biopsies. Impedance results revealed 14 had an abnormal acid:non-acid ratio. Twenty (26%) had a change in treatment based on these results. CONCLUSION: Average treatment change occurred 1:3, with abnormal EGD results always resulting in treatment change. Fundoplication may not be protective in all centers, and no patients had medications withdrawn with normal results.