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

Abstract:

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. TRIAL REGISTRATION:Clinicaltrials.gov Identifier NCT01364610.

journal_name

BMC Gastroenterol

journal_title

BMC gastroenterology

authors

Andrews CN,Sadowski DC,Lazarescu A,Williams C,Neshev E,Storr M,Au F,Heitman SJ

doi

10.1186/1471-230X-12-58

subject

Has Abstract

pub_date

2012-05-31 00:00:00

pages

58

issn

1471-230X

pii

1471-230X-12-58

journal_volume

12

pub_type

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