P94 Too many routine pH studies done at the time of bronchoscopy in children

Introduction Gastro-oesophageal reflux disease (GORD) in children is reflux together with symptoms or complications (e.g. oesophagitis or pulmonary aspiration). This can cause respiratory symptoms but is also an important comorbidity in children with underlying respiratory disease. In our tertiary centre we regularly perform pH/impedance studies, particularly at the time of a flexible bronchoscopy when investigating significant respiratory symptoms (e.g. chronic wet cough, recurrent pneumonia). When performing a study; either a single or dual probe is passed with the oesophageal sensor at T8 and position confirmed on X-ray. Following concerns that the percentage of abnormal studies was low and that there was a high number of failed studies, we reviewed our data. Methods A retrospective analysis of our database and electronic patient records reviewing all pH/Impedance studies carried out in 2018. Studies were categorised as abnormal; normal; indeterminate; or a failed study. (See definitions in table 1). Reasons for testing, results and outcome were recorded. Results 196 studies were performed; 148 pH post-bronchoscopy, 34 pH alone, and 14 impedance studies alone. The predominant finding was that there was a low rate of abnormal studies, the majority were normal. For patients undergoing impedance studies however there was a higher rate of abnormal studies. Another important finding was that patients Conclusion Changes to practice were implemented. Due to the high failure rate of pH studies among younger patients, impedance studies are now used in all ≥ 6-month olds, and a one-month trial of a Proton Pump Inhibitor in older children prior to a study. Implementation of the change in practice is hoped to result in less failed studies as referrals will only be made for patients when there is a strong clinical suspicion of reflux. Additionally, many more bronchoscopies can be done as a day admission as there will no longer be an overnight admission for pH study.