Catiele Antunes, MD1, Elinor Zhou, MD1, Jad P. Abi Mansour, MD1, Daniella Assis, MD1, Olaya Brewer Gutierrez, MD2, Christopher Fain, DO1, Ellen Stein, MD1, Joshua Sloan, DO1
1Johns Hopkins University School of Medicine, Baltimore, MD; 2Johns Hopkins University Hospital, Baltimore, MD
Introduction: High-resolution esophageal manometry (HReM) is used by gastroenterologists to evaluate a variety of symptoms including dysphagia, heartburn, and non-cardiac chest pain (NCCP). Traditionally, evaluation of those non-urgent conditions is done on outpatient basis; however, depending on practice and availability, HReM may be performed in the inpatient setting. In this study, we aim to characterize the population undergoing inpatient versus outpatient HReM. In addition, we aim to identify whether those inpatient studies resulted in any immediate action during the hospitalization in a specific subgroup.
Methods: This was a single-center retrospective study. Patients eighteen-years or older who underwent either inpatient or outpatient HReM between March 1st, 2015 and September 1st, 2018 were included. Demographic and clinical information were obtained from medical records.
Results: A total of 263 patients were included in this study: 76 patients who underwent inpatient HReM and 177 who underwent outpatient HReM. Demographic characteristics were similar between groups. Patients who underwent inpatient HReM had lower mean BMI (26 (±7.5) vs. 28 (±6), p=0.022) and were more likely to have diabetes (27.6% vs. 14.7%, p=0.021), chronic obstructive lung disease (COPD) (10.5% vs. 3.4%, p=0.034), heart failure (21% vs. 2.8%, p < 0.001) and history of aspiration (25% vs. 6.8%, p < 0.001) (Table 1). Symptoms reported by patients were similar among groups with exception of weight loss (52.5% vs. 22%, p < 0.001, inpatient vs. outpatient respectively). Dysphagia, gastroesophageal reflux disease (GERD) and NCCP were the main indication for HReM. The inpatient group had more dysphagia (67% vs. 54.2%, p=0.003) and less GERD as an indication (15.8% vs. 40.7%, p < 0.001). From the 76 inpatients, 23 (30.3%) underwent further intervention while inpatient (Table 2). On multivariate analysis, need for alternative diet/nutrition prior to HReM had a strong association with inpatient intervention, with an odds ratio (ORs) of 5.99 (95% confidence interval (CI) 1.53-23.39; p=0.01).
Discussion: There appear to be discrete differences between the inpatient and outpatient manometry groups. When performed in the inpatient setting HReM resulted in additional procedures in a small percentage of patients and need for alternative diet/nutrition was a predictor for further procedures. These findings indicate that inpatient manometry may be suitable in a selected group of patients.
Citation: Catiele Antunes, MD; Elinor Zhou, MD; Jad P. Abi Mansour, MD; Daniella Assis, MD; Olaya Brewer Gutierrez, MD; Christopher Fain, DO; Ellen Stein, MD; Joshua Sloan, DO. P0281 - HIGH-RESOLUTION ESOPHAGEAL MANOMETRY IN THE INPATIENT SETTING: IS THERE A ROLE?. Program No. P0281. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.