Post-fundoplication symptoms: the role for endoscopic assessment of fundoplication integrity.
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.
Jailwala
J
J
Division of Gastroenterology and Hepatology, Digestive Diseases Center and MCW Dysphagia Institute, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
Massey
B
B
Staff
D
D
Shaker
R
R
Hogan
W
W
D001466:Barium Sulfate; D003287:Contrast Media; D004724:Endoscopy; D004947:Esophagus / Q000000981:diagnostic imaging; D005260:Female; D018662:Fundoplication; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011859:Radiography
D003287:Contrast Media; D001466:Barium Sulfate