171 Rate of Conversion to Surgery: Oesophageal Physiology Studies

Abstract Aim This study aims to assess the proportion of patients that proceed to have hiatal surgery after oesophageal physiology studies. The results allow better planning in service development and workforce provision. Approximately 25% of the adult population suffer reflux symptoms, however, not all patients benefit from surgical intervention. UK data shows 1693 anti-reflux operations and 740 hiatal hernia repairs took place 2022-2023. Oesophageal physiology studies, i.e. high resolution pH manometry and 24-hour pH monitoring, are the gold standard investigation in such patients to determine diagnosis and guide management. Method All patients who underwent oesophageal physiology studies between January 2021 and May 2025 were assessed by case note analysis. All patients considered for surgery were discussed in our hiatal MDT. Whilst achalasia is relatively rare, these patients also pass through oesophageal physiology and so are also considered here. Patients with previous hiatal surgery were excluded. Results 320 patients presented for oesophageal physiology studies. 121 were offered surgery, 168 were not and 31 are awaiting outcomes. 51% had a hiatal hernia on OGD, 6.6% had Barrett’s oesophagus and 4.7% had achalasia. DeMeetser score had a mean of 42.5 for patients who have been offered surgery, and a score of 39.3 for those who were not. Conclusions 38% of patients undergoing oesophageal studies were offered surgical intervention across a four-year period in our benign unit. A further 9.7% are awaiting outcome. The data suggests that when planning surgical services, finances and workforce we should anticipate approximately 40% of these patients will go on to require surgery.