Quantification of fluoroscopic fundoplication anatomy: inter- and intraobserver reliability

Area of Science:

• Gastroenterology
• Medical Imaging
• Surgical Outcomes

Background:

• Postfundoplication dysphagia etiology is not fully understood, with potential links to gastroesophageal junction (GEJ) anatomical changes.
• Standardized barium swallows can objectively evaluate postsurgical GEJ anatomy.

Purpose of the Study:

• To identify reproducible, objectively measured postfundoplication GEJ anatomical features using structured barium swallows.
• To enable future comparisons between patients with and without dysphagia.

Main Methods:

• 31 patients underwent structured barium swallows with video-fluoroscopy 6-12 months postfundoplication.
• 11 GEJ anatomical variables were measured by a primary observer across multiple views, with repeat measurements for intraobserver consistency.
• Interobserver reliability was assessed with two additional trained readers.

Main Results:

• High interobserver reproducibility (good-excellent agreement) was found for measurements of maximal esophageal diameter, wrap opening diameter, posterior esophageal angle, anterior GEJ displacement, and axis deviation.
• Prone oblique views demonstrated the highest measurement reproducibility.
• Intraobserver consistency was excellent for 98% of measurements.

Conclusions:

• Structured barium swallows allow for reproducible, objective measurements of postfundoplication GEJ anatomy.
• These standardized measurements can be used to further investigate anatomical factors contributing to postfundoplication dysphagia.