Post-fundoplication symptoms: the role for endoscopic assessment of fundoplication integrity

Background: Fundoplication is now almost exclusively a laparoscopic procedu re. The aim of this study was the comparison of the diagnostic usefulness o f endoscopy and barium esophagram in the detection of fundoplication abnorm alities. Methods. Twenty-two patients presented with symptoms post-laparoscopic (Nis sen) fundoplication that included dysphagia (14 patients), heartburn (5 pat ients), dyspepsia (2 patients), and chest pain (1 patient). Barium esophagr am and upper endoscopy were performed in all patients and the results were compared. Key features included presence of esophagitis, resistance to endo scope passage, location of the wrap relative to the diaphragmatic hiatus, l ocation of squamocolumnar junction greater than 1 cm proximal to the wrap z one, and the appearance of the wrap (intact, loose, disrupted, or tight). Results; The key features explained symptoms in 20 of 22 patients. Endoscop y detected twice as many key features as radiography. Disruption of the wra p 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 acc urate in detecting an overly tight wrap. Conclusions: Endoscopic evaluation is more accurate than barium esophagram in detecting postfundoplication abnormalities. The appearance of the fundop lication wrap and an abnormal proximal location of the squamocolumnar junct ion appear to be major endoscopic clues in diagnosis of post-fundoplication problems.