PTU-124 Development of a specialist anti-reflux service

Introduction Surgical management of anatomical and functional failure of the lower oesophageal sphincter is becoming increasingly complex with advances in diagnostics, eg. high-resolution manometry (HRM), and further therapeutic options such as magnetic-bead sphincter augmentation (MSA).1With the increasing incidence in functional bowel / motility disorders which may create worse surgical outcomes, there is a need for specialisation in this field. We report on the development of a specialist anti-reflux service including the changing role of surgery and the increasing importance of physiology investigations. Method Data was retrieved from a prospective databases maintained by the clinical measurements and surgical departments to identify patients undergoing physiology investigations and surgical intervention over a 5 year period 2010-2014, since the start of the specialist service. Surgical data was cross-referenced against hospital coding data. Results Following introduction of a specialist anti-reflux clinic there has been a sustained rise in new referrals to the clinic (Figure 1) and patients treated surgically. Recent years have also seen a trend to increasing use of second generation physiology investigations such aswireless pH monitoring and HRM, as well as a rise in the total number of investigations ( Figure 2 ). A peak in the upward trend was associated with the introduction of MSA, with subsequent divergence of MSA and fundoplication reflecting the relative popularity of these procedures ( Figure 3 ). There was no significant change in the frequency of complex para-oesophageal hernia repair over the same period. Conclusion Introduction of a specialist anti-reflux service has led to a rise in the number of physiology investigation requested and patients treated operatively. Magnetic-bead sphincter augmentation appears to be a more acceptable alternative for patients than traditional fundoplication. Guidance and service requirements need to be developed including the identification of standards and quality indicators in the field of anti-reflux surgery to optimise patient outcomes in a field where an increased range of investigation and management expertise are required. Disclosure of interest None Declared. Reference Bonavina, et al. Ther Adv Gastroenterol. 2013;6(4):261-8