Unsedated peroral wireless pH capsule placement vs. standard pH testing: A randomized study and cost analysis

被引:9
作者
Andrews, Christopher N. [1 ]
Sadowski, Daniel C. [2 ]
Lazarescu, Adriana [2 ]
Williams, Chad [1 ]
Neshev, Emil [1 ]
Storr, Martin [1 ,3 ]
Au, Flora [1 ]
Heitman, Steven J. [1 ]
机构
[1] Univ Calgary, Div Gastroenterol, Calgary, AB, Canada
[2] Univ Alberta Hosp, GI Motil Lab, Edmonton, AB T6G 2B7, Canada
[3] Univ Munich, Munich, Germany
关键词
Esophagus; Gastroesophageal reflux disease; pH-metry; Clinical trial; CLINICALLY SIGNIFICANT DIFFERENCE; ANALOG SCALE PAIN; REFLUX DISEASE; BRAVO WIRELESS; TOLERABILITY; MANOMETRY; SYSTEMS; IMPACT; CARE;
D O I
10.1186/1471-230X-12-58
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background: Wireless capsule pH-metry (WC) is better tolerated than standard nasal pH catheter (SC), but endoscopic placement is expensive. Aims: to confirm that non-endoscopic peroral manometric placement of WC is as effective and better tolerated than SC and to perform a cost analysis of the available esophageal pH-metry methods. Methods: Randomized trial at 2 centers. Patients referred for esophageal pH testing were randomly assigned to WC with unsedated peroral placement or SC after esophageal manometry (ESM). Primary outcome was overall discomfort with pH-metry. Costs of 3 different pH-metry strategies were analyzed: 1) ESM + SC, 2) ESM + WC and 3) endoscopically placed WC (EGD + WC) using publicly funded health care system perspective. Results: 86 patients (mean age 51 +/- 2 years, 71% female) were enrolled. Overall discomfort score was less in WC than in SC patients (26 +/- 4 mm vs 39 +/- 4 mm VAS, respectively, p = 0.012) but there were no significant group differences in throat, chest, or overall discomfort during placement. Overall failure rate was 7% in the SC group vs 12% in the WC group (p = 0.71). Per patient costs ($Canadian) were $1475 for EGD + WC, $1014 for ESM + WC, and $906 for ESM + SC. Decreasing the failure rate of ESM + WC from 12% to 5% decreased the cost of ESM + WC to $991. The ESM + SC and ESM + WC strategies became equivalent when the cost of the WC device was dropped from $292 to $193. Conclusions: Unsedated peroral WC insertion is better tolerated than SC pH-metry both overall and during placement. Although WC is more costly, the extra expense is partially offset when the higher patient and caregiver time costs of SC are considered.
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页数:8
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