Endoscopic assessment of failed fundoplications differs between endoscopists

Area of Science:

• Gastroenterology
• Foregut Surgery
• Surgical Outcomes

Background:

• Gastroesophageal reflux disease (GERD) is commonly treated with laparoscopic antireflux surgery (ARS).
• A subset of patients require reoperation due to treatment failure or complications.
• Esophagogastroduodenoscopy (EGD) is vital for planning redo-ARS by assessing fundoplication integrity.

Purpose of the Study:

• To compare EGD findings from external endoscopists with those from internal endoscopists (operating surgeons).
• To identify discrepancies in the documentation of fundoplication failure patterns before redo-ARS.

Main Methods:

• Retrospective chart review of patients undergoing redo-ARS at a tertiary center (November 2016 - March 2023).
• Inclusion of patients with both external and internal preoperative EGD reports.
• Comparative analysis of findings documented in external versus internal EGD reports.

Main Results:

• 181 patients with available EGD reports were analyzed.
• External reports less frequently mentioned prior fundoplication (38.9%).
• External endoscopists reported significantly lower rates of Barrett's esophagus, slipped, disrupted, intrathoracic, and twisted fundoplications compared to surgeons.

Conclusions:

• External EGD reports for failed fundoplications are often incomplete and lack critical details.
• Discrepancies stem from differences in training and experience in evaluating post-fundoplication anatomy.
• Standardized definitions and enhanced training are recommended to improve diagnostic accuracy.