Faculty Collaboration Database

Post-fundoplication symptoms: the role for endoscopic assessment of fundoplication integrity. Gastrointest Endosc 2001 Sep;54(3):351-6

Date

08/28/2001

Pubmed ID

11522977

DOI

10.1067/mge.2001.117548

Scopus ID

2-s2.0-0035458858 (requires institutional sign-in at Scopus site)   24 Citations

Abstract

BACKGROUND: Fundoplication is now almost exclusively a laparoscopic procedure. The aim of this study was the comparison of the diagnostic usefulness of endoscopy and barium esophagram in the detection of fundoplication abnormalities.

METHODS: Twenty-two patients presented with symptoms post-laparoscopic (Nissen) fundoplication that included dysphagia (14 patients), heartburn (5 patients), dyspepsia (2 patients), and chest pain (1 patient). Barium esophagram and upper endoscopy were performed in all patients and the results were compared. Key features included presence of esophagitis, resistance to endoscope passage, location of the wrap relative to the diaphragmatic hiatus, location of squamocolumnar junction greater than 1 cm proximal to the wrap zone, and the appearance of the wrap (intact, loose, disrupted, or tight).

RESULTS: The key features explained symptoms in 20 of 22 patients. Endoscopy detected twice as many key features as radiography. Disruption of the wrap or excessive proximal location of the squamocolumnar junction proximal to the wrap zone were the most incriminating endoscopic findings. Resistance to endoscope passage was rarely encountered and the esophagram was more accurate in detecting an overly tight wrap.

CONCLUSIONS: Endoscopic evaluation is more accurate than barium esophagram in detecting post-fundoplication abnormalities. The appearance of the fundoplication wrap and an abnormal proximal location of the squamocolumnar junction appear to be major endoscopic clues in diagnosis of post-fundoplication problems.

Author List

Jailwala J, Massey B, Staff D, Shaker R, Hogan W

Authors

Benson T. Massey MD Professor in the Medicine department at Medical College of Wisconsin
Reza Shaker MD Assoc Provost, Sr Assoc Dean, Ctr Dir, Chief, Prof in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Barium Sulfate
Contrast Media
Endoscopy
Esophagus
Female
Fundoplication
Humans
Male
Middle Aged
Postoperative Complications
Radiography