Use of Preoperative Endoscopic Capsule-Based pH Testing Before Bariatric Surgery.

BACKGROUND: Vertical sleeve gastrectomy is the most performed bariatric operation in the US; however, a significant number of patients suffer from persistent or new-onset reflux. No consensus for objective preoperative evaluation in these patients exists. We compared capsule-based pH testing vs GERD symptom scoring to determine extent of preoperative GERD to aid in procedure selection for bariatric surgery. STUDY DESIGN: An IRB-approved retrospective review of consecutive patients at a single institution was performed from April 2021 to December 2022. During initial consultation for bariatric surgery, a validated GERD symptom subjective survey was administered. All patients demonstrating interest in sleeve gastrectomy or had a history of reflux underwent upper endoscopy with capsule-based pH testing. RESULTS: Sixty-two patients underwent preoperative endoscopy with capsule-based pH testing and completed GERD symptom assessment survey(s). Median BMI was 43.4 kg/m 2 and 66.1% of patients were not taking a proton-pump inhibitor before performance of pH testing. There was negligible linear association between the objective DeMeester score obtained by capsule-based pH probe and GERD symptom survey scores. Median GERD symptom survey scores did not differ between patients with and without a diagnosis of GERD based on pH testing (all p values >0.11). CONCLUSIONS: An objective method for identifying severe GERD in the preoperative assessment may aid in the decision tree for procedure selection and informed consent process. Patients with significant preoperative GERD may be at higher risk for future GERD-related sleeve complications. Capsule-based pH testing may prove to be superior to subjective symptom scoring systems in this patient population.

Accelerated partial breast irradiation and posttreatment imaging evaluation.

Accelerated partial breast irradiation (APBI) is a technique that allows irradiation of only that part of the breast that is at greatest risk for recurrence of breast cancer. Because only a portion of the breast is irradiated, APBI can be performed in a relatively short period of time, usually in 5 days rather than the traditional 6 weeks. When used in carefully selected patients, APBI also allows normal portions of the breast parenchyma and regional vital organs to be spared from unnecessary irradiation. Common post-APBI imaging findings include focal skin thickening, seroma, scar, and skin retraction. Studies are underway that will compare a cohort of patients who underwent whole-breast irradiation with a cohort who underwent APBI to help determine whether the two techniques lead to significantly different imaging findings. Additional multicenter studies will be needed to document and analyze any such differences. In the future, APBI may play a significant role in selected patients, with pretherapy dynamic contrast material-enhanced magnetic resonance imaging of the breast possibly aiding in the selection process.