1 / 45

Endoscopic Diagnosis of Hiatal Hernia

Endoscopic Diagnosis of Hiatal Hernia. Gilbert Simoni , MD Advanced Gastroenterology, Inc And Chief, division of gastroenterology Los Robles Hospital and Medical Center West Coast Reflux Society- Inaugural Meeting November 10 th , 2012.

meghan
Download Presentation

Endoscopic Diagnosis of Hiatal Hernia

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Endoscopic Diagnosis of Hiatal Hernia Gilbert Simoni, MD Advanced Gastroenterology, Inc And Chief, division of gastroenterology Los Robles Hospital and Medical Center West Coast Reflux Society- Inaugural Meeting November 10th, 2012

  2. Figure 1 Lower esophageal sphincter (LES) fibers. GI Motility online (May 2006) | doi:10.1038/gimo52

  3. Ways to “skin a cat”? • Text book definitions • Typical EGD diagnosis • Hill Grade • The “Simoni” method • Imaging

  4. Text book • There are four types of hiatal hernia: • Type I hiatal hernia • Type II (paraesophageal) hiatal hernia • Type III hiatal hernia • Type IV hiatal hernia

  5. Type I hiatal hernia:

  6. Type II (paraesophageal) hiatal hernia:

  7. Type III hiatal hernia:

  8. Type IV hiatal hernia:

  9. Typical EGD reports • Incompetent GEJ • Small • Medium (moderate) • Large

  10. A normal valve(No Hiatal Hernia)

  11. Incompetent GEJ

  12. Small Hiatal Hernia

  13. Medium size Hiatal Hernia

  14. Large Hiatal Hernia

  15. Hill Grade

  16. Axial measurement

  17. Transverse measurement

  18. Imaging • Upper GI: • Axial heightfromdiaphragm to • uppermostgastricfolds

  19. The “Simoni” Method The best of all worlds?

  20. Impelementing BRAVO pH System

  21. Considered the best test for the diagnosis of gastroesophageal reflux disease (GERD) Greater sensitivity than endoscopy and greater specificity than an empiric trial of proton pump inhibitor (PPI) therapy.

  22. Indications • GERD • Chronic Cough • Laryngitis • LPR • Chest pain (non-cardiac) • Regurgitation • Post-ARS evaluation • Failure to respond to PPIs

  23. Current Technology and it’s Limitations Catheter Based Systems: • Patient Intolerance • Uncomfortable • Pharyngeal and Throat Discomfort • Runny Nose • Artifact Prone • Alters Regular Diet and Activity • Requires Manometry?

  24. Bravo pH System™ • Catheter-Free pH Monitoring System • pH Capsule attached to the esophageal wall transmits data to pager-sized Receiver • Eliminates uncomfortable 24-hr trans-nasal catheter • Allows normal activities, showering and does not interfere with sleeping

  25. Bravo pH System Components 1) Bravo Calibration Stand 2) Bravo pH Receiver 3) Bravo pH Capsule with Delivery System 4) Bravo pH Capsule 5) Bravo DataLink 6) Lithium AA Battery 7) Calibration Solutions (pH 7.01 & 1.07) 8) POLYGRAM NET pH Testing Application • Optional: Vacuum Pump

  26. Bravo pH Capsule with Delivery System • For trans-nasal or trans-oral placement • Single-Use item • One-handed operation • 100 cm long with working length of 80 cm • Distance marks every 5 cm up to 60 cm Handle Catheter pH Capsule

  27. Bravo pH Capsule with Delivery System • Bravo pH Capsule placed via nose or mouth • Trans-nasal placement relative to manometrically identified LES upper boarder • Trans-orally placement relative to endoscopically identified Scuama-Columnar Junction Flexible Tip pH Capsule

  28. Bravo pH Capsule • pH Capsule measures esophageal pH with Antimony pH sensor • Uses Radio-Telemetry to send data to Receiver • Dimensions: 6 x 6.3 x 26 mm • Contains: suction chamber, locking pin, 2 batteries, PCB, transmitter and pH sensor+ref. pH Capsule

  29. Capsule Attachment Step 1 Position Bravo Capsule Step 2 Apply Suction Step 3 Advance Pin Step 4 Release Capsule Step 5 Begin pH Recording

  30. Bravo pH Receiver • pH Capsule transmits data to pager-sized Receiver • Eliminates uncomfortable 24-hr trans-nasal catheter • Allows showering and does not interfere with sleeping Receiver pH Capsule

  31. Digital Radio-Telemetry • Use Digital Radio-Telemetry • Capsule measures pH every 6 sec and transmits data to receiver every 12 sec • Keep the receiver within 1m to prevent data loss (range up to 3m)

  32. Features and Benefits

  33. Features and Benefits, cont’

  34. Bravo Performs Clinically - Summary • Bravo Market Studies Confirm/Validate Clinical Performance • Bravo’s Capsule is Comparable to the Conventional Catheter in Quantifying Esophageal pH* • The Bravo “Catheter-Free System” should Lead to Increased Patient Acceptance and Compliance of this Test for GERD*

  35. Report Templates

  36. RAPID pH Summary Simplified User Interface Intuitive software navigation Streamlined pH monitoring workflow Easy Study Management Reporting Options to Meet Your Needs Multiple options for graphically displaying study data Multiple templates enable customized reporting Flexible Integration Solutions Enables network printing and email options for reporting Enables study management and storage on network drives

  37. Gilbert Simoni, MD 805-719-0244 gsimoni@AGImedical.com

More Related