1. Esophageal Function Testing Patterns in the Evaluation and Management of Lung Transplantation: Results of a National Survey.
- Author
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Yamamoto M, Kamal AN, Gabbard S, Clarke J, Gyawali CP, and Leiman DA
- Subjects
- Humans, Surveys and Questionnaires, Health Care Surveys, Esophagus physiopathology, Esophagus surgery, Lung Transplantation statistics & numerical data, Gastroesophageal Reflux diagnosis, Gastroesophageal Reflux surgery, Manometry methods, Manometry statistics & numerical data, Practice Patterns, Physicians' statistics & numerical data, Esophageal Motility Disorders diagnosis, Esophageal Motility Disorders physiopathology
- Abstract
Goals: We surveyed esophageal motility laboratories affiliated with adult pulmonary transplant centers to determine esophageal function testing (EFT) practices., Background: Gastroesophageal reflux and esophageal dysmotility are associated with worse lung transplant outcomes, yet no consensus guidelines for EFT exist in this population., Study: A deidentified online survey was sent to gastrointestinal motility laboratory directors of 49 academic and community-affiliated medical centers that perform lung transplants. Practice characteristics, including annual lung transplant volume and institutional EFT practices pre-lung transplantation and post-lung transplantation were queried. Respondents were categorized by transplant volume into small and large programs based on median annual volume., Results: Among 35 respondents (71% response rate), the median annual transplant volume was 37, and there were 18 large programs. Institutional EFT protocols were used pretransplant by 24 programs (68.6%) and post-transplant by 12 programs (34.2%). Among small and large programs, 52.9% and 72.2% always obtained high-resolution manometry before transplant, respectively. Endoscopy before transplant was performed more often in small programs (n=17, 100%) compared with large programs (n=15,83.3%). Pretransplant endoscopy ( P =0.04), barium esophagram ( P <0.01), and high-resolution manometry ( P =0.04) were more common than post-transplant. In contrast, post-transplant reflux monitoring off-therapy was more common than pretransplant ( P =0.01). In general, pulmonologists direct referrals for EFT and gastroenterology consultation (n=28, 80.0%), with symptoms primarily prompting testing., Conclusions: In the absence of established guidelines, substantial variability exists in pretransplant and post-transplant EFT, directed by pulmonologists. Standardized EFT protocols and gastroenterologist-directed management of esophageal dysfunction has potential to improve lung transplant outcomes., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2024
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