ENDOSCOPIC EVALUATION OF POST-FUNDOPLICATION ANATOMY AND CORRELATION WITH SYMPTOMATOLOGY

Area of Science:

• Gastroenterology
• Surgical Endoscopy
• Anatomy

Background:

• Upper digestive endoscopy is crucial for evaluating postoperative symptoms after fundoplication.
• Current endoscopic assessment of fundoplication anatomy lacks standardization, leading to inconsistent interpretations.
• Standardization is needed for accurate assessment of fundoplication anatomy and complications.

Purpose of the Study:

• To evaluate the frequency of postoperative fundoplication abnormalities using a modified endoscopic classification.
• To correlate endoscopic findings with patient clinical symptoms.

Main Methods:

• A prospective observational study involving 100 patients who underwent fundoplication.
• Patients completed questionnaires for symptom data collection.
• Endoscopic assessment utilized a modified classification focusing on gastroesophageal junction position, valve position, valve conformation, and paraesophageal hernia.

Main Results:

• 46% of patients exhibited endoscopic abnormalities in fundoplication anatomy.
• Slipped fundoplication (gastroesophageal junction above pressure zone) and migrated fundoplication were significantly associated with postoperative symptoms.
• No correlation was found between symptom occurrence and valve conformation (total, partial, or twisted).

Conclusions:

• The proposed modified endoscopic classification for fundoplication anatomy is reproducible.
• This classification appears to correlate with patient symptomatology.
• Slipped and migrated fundoplication represent the most frequent abnormalities and are linked to symptoms.