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Logo of bmcgastBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Gastroenterology
 
BMC Gastroenterol. 2012; 12: 58.
Published online May 31, 2012. doi:  10.1186/1471-230X-12-58
PMCID: PMC3413593
Unsedated peroral wireless pH capsule placement vs. standard pH testing: A randomized study and cost analysis
Christopher N Andrews,corresponding author1 Daniel C Sadowski,2 Adriana Lazarescu,2 Chad Williams,1 Emil Neshev,1 Martin Storr,1,3 Flora Au,1 and Steven J Heitman1
1Division of Gastroenterology, University of Calgary, Calgary, Canada
2GI Motility Lab, University of Alberta Hospital, Edmonton, AB, Canada
3Ludwig Maximilians University, Munich, Germany
corresponding authorCorresponding author.
Christopher N Andrews: motility/at/ucalgary.ca; Daniel C Sadowski: dan.sadowski/at/ualberta.ca; Adriana Lazarescu: adriana.lazarescu/at/ualberta.ca; Chad Williams: ciwillia/at/me.com; Emil Neshev: emilnesh/at/hotmail.com; Martin Storr: mstorr/at/ucalgary.ca; Flora Au: fau/at/ucalgary.ca; Steven J Heitman: Steven.Heitman/at/albertahealthservices.ca
Received January 5, 2012; Accepted May 31, 2012.
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
Keywords: Esophagus, Gastroesophageal reflux disease, pH-metry, Clinical trial
Articles from BMC Gastroenterology are provided here courtesy of
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