Endoscopic appraisal of the gastroesophageal valve after antireflux surgery.
OBJECTIVE
Little consensus exists regarding the endoscopic assessment of the esophagogastric junction after antireflux surgery. The purpose of this report is to characterize the gastroesophageal valve appearance unique to each type of antireflux procedure and to introduce an endoscopic lexicon by which to describe this anatomic region.


METHODS
Endoscopic images were obtained from patients who had undergone any one of the following procedures: Nissen, Collis-Nissen, Toupet, and Dor fundoplications and Hill repair. Images were excluded if patients had any symptoms of heartburn, regurgitation, dysphagia, chest pain, or gas bloat or if they were using antisecretory medication. Seven photographs per operation type were evaluated by experienced surgeons and gastroenterologists tasked with describing defining characteristics of each procedure.


RESULTS
Ten valve criteria were developed to uniquely identify and quantify the ideal endoscopic appearance of each procedure. Illustrations were created to clearly depict those traits.


CONCLUSIONS
Using 10 gastroesophageal valve criteria, the key components of a successful functional repair of the esophagogastric junction were defined. These criteria can be employed when evaluating upper gastrointestinal complaints after antireflux surgery and may ultimately serve as a dependable outcome measure.
Jobe
Blair A
BA
Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA.
Kahrilas
Peter J
PJ
Vernon
Ashley H
AH
Sandone
Corinne
C
Gopal
Deepak V
DV
Swanstrom
Lee L
LL
Aye
Ralph W
RW
Hill
Lucius D
LD
Hunter
John G
JG
D004943:Esophagogastric Junction / Q000473:pathology / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D018662:Fundoplication / Q000379:methods*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D011184:Postoperative Period; D016896:Treatment Outcome