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

BMC Gastroenterology

Research Article

Emil Neshev¹  Steven J Heitman¹  Christopher N Andrews¹  Chad Williams¹  Flora Au¹  Martin Storr²  Daniel C Sadowski³  Adriana Lazarescu³ 

[1] Division of Gastroenterology, University of Calgary, Calgary, Canada;Division of Gastroenterology, University of Calgary, Calgary, Canada;Ludwig Maximilians University, Munich, Germany;GI Motility Lab, University of Alberta Hospital, Edmonton, AB, Canada;

关键词: Esophagus;    Gastroesophageal reflux disease;    pH-metry;    Clinical trial;   

DOI  :  10.1186/1471-230X-12-58

 received in 2012-01-05, accepted in 2012-05-31,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundWireless 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.MethodsRandomized 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.Results86 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.ConclusionsUnsedated 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.Trial registrationClinicaltrials.gov Identifier NCT01364610

【 授权许可】

CC BY   
© Andrews et al.; licensee BioMed Central Ltd. 2012