1020 Pre-Operative Investigation of Symptomatic GORD Patients and Hiatus Hernia: Are We Doing Too Many?

Abstract

Abstract Aim To evaluate the clinical utility of diagnostic tests such as upper endoscopy, barium swallow, oesophageal manometry and pH studies that are commonly performed in patients prior to undergoing a hiatus hernia repair and determine whether one or more of these investigations can be omitted in our practice. Method A retrospective analysis was conducted on 215 patients from September 2012 to August 2022 with symptoms of gastro-oesophageal reflux disease (GORD) undergoing hiatus hernia repair. Endoscopy was used as the gold standard to evaluate the performance of oesophageal manometry and barium swallow findings in diagnosing hiatus hernia (HH). Results Endoscopy had the highest detection rate of HH (76.9%), followed by barium swallow which had a higher detection rate of HH (51.8%), specificity and positive predictive value compared to manometry studies (42.1%), however, this did not reach statistical significance (p = 0.07). There was no significant difference between endoscopy and barium swallow (p<0.05) and oesophageal manometry and endoscopy (p<0.00001) in the detection of HH. Conclusions All three investigations appear to be useful for the detection of GORD and hiatus hernia prior to treatment. However, the routine use of manometry pH studies may not be crucial and therefore could be performed selectively in patients. Further prospective analysis comparing preoperative and intraoperative findings could be carried out for each diagnostic test to assess whether the significance of our results is applicable to all populations and to determine whether one of these tests can be safely omitted or performed more selectively.