PS01.050: IMPACT OF FUNDOPLICATION IN THE OUTCOME OF TRACHEAL STENOSIS PATIENTS WITH GASTROESOPHAGEAL ACID REFLUX: A RETROSPECTIVE PROPENSITY SCORE-MATCHED STUDY

Abstract

Abstract Background Abnormal gastroesophageal acid reflux (GEaR) is often found in laryngeal diseases and tracheal stenosis. The study focuses on the prevalence of GEaR and the impact of anti-reflux surgery in the outcome of post-intubation tracheal stenosis Methods Prospective non-randomized study of patients with post-intubation tracheal stenosis. Inclusion criteria: adult with subglottic or recurrent tracheal stenosis. Exclusion criteria: previous gastroesophageal surgery. Patients were submitted to esophageal manometry and pH study. Patients were divided in 3 groups: one with pH study negative, one with pH study positive receiving treatment with proton pump inhibitor and one with pH study positive submitted to Nissen fundoplication. Follow-up was 24 months. Outcome was considered satisfactory when airway stenosis could be successfully managed by resection, no need for dilatation or definitive decannulation. In order to match the 3 groups, it was used a propensity score match (PSM) and them they were compared. Statistical significance was assumed for P < 0.05 Results Prevalence of GEaR was assessed in 175 patients. Abnormal pH study was found in 74 (42%) with a predominance of supine reflux. Typical GEaR symptoms were found in only 21%. Abnormal manometry was found in 37%, and hypotonic lower sphincter was the most frequent finding. Of the 124 patients who met the inclusion criteria, pH study was normal in 72 and abnormal in 52 (32 underwent clinical treatment and 20 nissen fundoplication). There were no peri-operative complications. After PSM, patients with abnormal pH study submitted to fundoplication had a higher chance of a satisfactory outcome of the stenosis compared to those treated with Omeprazole (OR 5.31; CI 2.41–11.07; P = 0.03) which was similar to those without GEaR (OR 1; CI 0.47–2.11; P = 0.99). Patients without GeAR had a higher chance of resolution of the tracheal stenosis compared to the patients treated with Omeprazole (OR 3.54; CI 2.02–6.19; P = 0.02). Conclusion Asymptomatic GEaR is a frequent finding in tracheal stenosis. Nissen fundoplication was safe and effective in selected patients with tracheal stenosis and GEaR. Control of the airway stenosis was superior after fundoplication if compared to medical treatment of GEaR. A larger prospective randomized multicenter trial is needed to confirm these findings Disclosure All authors have declared no conflicts of interest.